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FOR OFFICE USE ONLY] <br />R. ec¢ived .By: ~q <br />Zo,~,g wu.,~Uo~': /y I <br />Da~.: ~'~-I /- q? I <br /> <br /> MARION COUNTY BUILDING INSPECTION FOR OFFICE USE ONLY <br /> 220 High Slreet NE <br /> <br /> BU~D~G PER~ APPLICATION <br />CO~LE~ ~L SEC~ONS, 1 T~OUGH 4 MARION ~OUNTY <br />L lob ~ri~tio. BUILDING INSPECTION <br /> <br />RESIDENTIAL ............................. COMMERCIAL ( ) New Use of Structure: <br /> <br /> ( )Addition ( )Relo~alion ( )Addition <br /> ( Imte,abo~ ( )r~,.oUtlo. ( )mter~uon <br /> ~Acc~ ( )~er ( )~eof~u~ ( )~er <br />~..,r~wo~: /~.,~, ~/~. L~rp~ ............................... <br />:i I <br /> <br />2. Locat|ou of Installation /l~fl{f~[~/l~ <br /> <br />Contractor Information I <br /> <br /> ) I o~, reside ~, ~ ~ m~idc ~ ~ ~d stratum, <br /> ) I ~d~nd ~at I must ~smr as a ~tm~ ~t~c~ ff ~c s~um ~ soM or offend for sale ~ or u~ c~cfi~, <br /> <br />If I him subcontractor% I will Mm only sub~ontracton r,giste~l with the Constmaio~ Ctntractor~ Ilo~rd, If I change my m/nd and do hlro a g~noral contractor, I will contract <br />with a ~mtractor who is mglstomd withe Constm~tie~ C~tmctor'$ BoaRt, and willinm~liately not~y Marion County of the name of the contractor, <br /> <br /> (v~IamaregistemdbtfilderOffthoauth°fiZedmpms~mti'~°fam;istemdbuiMer' ~/~ml ~ qZ;~. <br /> <br />4. Fee Schedule <br />,C V'^~VA~O~ (s~"vm.tion s~.d.,lo'" i ":' <br />i6 d~t~nninevaluation ~s~ ~ : ' <br />squa~ f~ge.) V~uafion: $~ <br /> <br />B. Miscellaneous Fee~' <br /> O) Driveway ~,l~ueo@ $7.S0 <br /> (2) Driveway w/oourb@ $17.~ <br /> <br /> O) Site Plan Renew (c~fl ~ly) ~ $79,~ <br /> <br /> (4) Additional Plan Renews ot Add~dms <br /> <br /> (5) ~vesfiga~ Fee <br /> <br /> (6) ~e~m Fe~ ~ $25.00 ~ <br /> ~) O~er ~s~e~ms not ~s~ a~ve <br /> <br />TOTAL <br /> <br />I hereby certify that the above information is correct and that I have read and understand thc Information Noti~ to Property Owners about ConstmcLion Respeosibil.itles on the <br />reverse side of this form, <br /> <br /> ' , p '¢. *lectrioal, plumbing and mechanical work require sepetate permils, Check wlth Marion County Building Impoctlon I~fom mbmittind th~ applleallon. <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />