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FOR ~FFICE~USE ONLY <br />R¢ceiv~'~< ~ ~ <br />Zoning Val}~dat/on: ~ <br />Date: ~~ <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. Job Description <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE ~ <br /> <br />FOR OFFICE USE ONLY <br /> <br />BUILDING PERMIT APPLICAT} i0I I 0[I IT¥ <br /> 81JiLOI 6 i P£CT 0hl <br /> <br />RESIDENTIAL COMMERCiAL ( )New [ Useof S~mcture: <br />( )Addition ( )Relocation ( )Addition ( )Sign [ /K7'..~4.~~ ~'~.~.~ <br /> <br /> ( ) Accessory ~ ( )Other ( )ChangeofOccupancy ~Other ~ [-~ ~-~ <br /> <br />Imps( ) or l~ffter( ) }No, Stofie~ ~ ~OecumntLoadorNumberofEmployees ]Ne. Bedrooms: <br /> <br />Location of Installation <br /> <br />I Owner ~r~t//,~,~- ~.~- '~'~" ' ' , ................. <br />Dr qTZ <br /> Subdivision ~t Bk~k <br /> Mob~e l-[~e Pa~ Space ~ <br /> Commmdb We~ ( ) Cily~ ...... <br /> <br />3. Contractor Information <br /> <br /> ) I own, reside in. or w/Il reside in the completed stmctum. <br /> <br /> ) I understand that I must register as a construction contractor if the structure is sold or offered ~or sale before or ulmn completion. <br /> <br /> )._! will be my own gcmeral contractor, <br /> <br />_~ ~ ;~ ! ! "'g" · ' ' · ' ' ' ' ..i~2~.ar , a~d iii immcdlatoly notify Marion Cot n~y of the name et' the com:'actor, <br /> <br /> ( ) I am a regis~mfi bufl~er OR ~e au~ofized m~senmfive of aimgis~md builder. <br /> <br /> Architect name: ~ "[ Ma~g Agdtess: ] phone; <br /> I <br /> <br />4. Fee Schedule <br /> <br />A, VALUA'IION (See "Valuation Schedule" <br /> to del~nnine valuation based on <br /> square footage.) <br /> (1) Permit <br /> <br /> (2) 5% Slate Stlrcharg¢ (,05 x Al) <br /> (3) Structural PLan Review (,65% x Al) <br /> <br /> (4) Fire & Life Safety Plan Review (.40% <br /> <br />Valuation: <br /> <br /> = <br /> <br />B. MLseellaneous Fees <br />(1) Driveway w/curb @ $7,50 <br />(~) Driveway w/o curb @ $17,00 = ........ <br />(3) Site Plan Review (commercial only) @ $79.00 <br />(4) Additional Plan Reviews or Addendums = __ <br />(5) Investigation Fee = __ <br />(6) Reinspection Fee @ $25.00 = __ <br /> <br /> , (7) Other Inspections not listed above <br /> <br />reverse side of thisfform, <br />Name of Applicant (I lease I [' ~ Phone: <br /> <br /> / <br /> <br />MC I5-73 Rev, 11/91 <br /> <br /> <br />