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MARION COUNTY BUILDING INSPECTION ~ ONLY <br /> 220Highs · ...... [~t: /0 [Rear: /Q ! <br /> <br />COMt'I~TE ALL SECTIONS, 1 THROUGH 4 MARION C0U ,4 Y <br />1. Job Description BUILDING INSPECTION <br /> <br />RESIDENTIAL COMMt~CIAL ( )New <br />() Ad4itlon ( )Relocation ( )Addition ( )Sign <br />( )~ ( )~ ( )D~oU~ <br />( )~ <br />(~Access~ ( )~er ( )~ge~cy ( )O~er <br /> <br />2. Locatlon0flngtallation l~l bm Ore.. ~7~.25~ <br /> <br />Su~sion ~ Bl~k <br />~dm ~/ Lm~ ~$ r A~S ~g.~t ~a Comer fro CmmuffityW~( ) City <br /> <br />If I him subco~mctors, I will him Only ~ul~onU'~tors mgister~ with the ~mstmctlon Contractors Board. If I change my mind :md do hire a general contractor, I will contract <br />with a ¢c~ltra¢~of who is ff~.gismred withe Con,traction CmWactof's Board, and will JmIned~tely not~ Marion County of the name of th* e,q.ontraetor. <br /> <br /> (6~ Iam aveglsteredbuflderORtheauthofiz~d~pre~enmdveofaregis~redbuild~r. ~J /e ~;, ~. r~ q-/Jo b <br /> ,4,',,,,,,,;"X2 I 1Phone: <br />4. Fee Schedule <br /> <br />VALUATION' (Bee "Valuation Schedule" <br /> <br />aqua~ footage,) <br /> <br />(I) Permit Fe~ <br /> <br />(2) 5% State $~mhaqle 605 x Al) <br /> <br />O) Stmctura/Plan Rovicw 665% x A1 ) <br />(4) Fire & Lif~ Safety Plan Review (.40~ x Al) <br /> <br />Valuation: $ ~t~Ot9 <br /> <br /> = /, q$ <br /> <br />B. Miscellaneous Fees <br />(I) Driveway w[oJrb @ 87.50 -- <br />(2) Driveway w/o curb @ $17.00 -- <br />O) Site Plan Review (commercial only) @ $79,00 = __ <br />(4) Additional Plan Reviews or Addendm,ns = __ <br />(5) Inv~sdgatica Fee ~- -- <br />(6) Reinspemion F¢~ @ $25,00 -- __ <br />(7) Other Inspections not listed above = <br />REc , ?/.,ay <br /> <br />I hereby certify that the above information is correct and that I have read and understand the Information Ne~ice to Property Owners about Construction Responsibilities on thc <br /> <br /> ~ ~ .... p . , ~ g ' q ' ~ ~ *. Check wi~ Mation County Building Inspe~ion ~fo~ su~ittNg mi~ app~ca~. <br /> <br />MC 15-73 Rev, 11/91 <br /> <br /> <br />