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MARION COUNTY BUILDING INSPECTION ~ ONLY <br /> 220 High Street NE city Setback Requ/rements: <br /> <br /> S:00am - 4:30pm Phon~ 588-5147 <br /> <br /> BUILDING PERMIT APPLICATION <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />2. Location of Installation <br /> <br />............. ~mmro,zl~ ~j~.... ., si~ ~o. ~ <br />Mobile I{om~ Pa~ S~e~ ~ <br /> <br /> / L~De~ /~B i A¢~ ~g.~t ~d ~m~r ~ Commu~q~,W~( ) City <br />~Width /~0 '" Pdva~We]l ( ) $p~g <br /> <br />3. Contractor Information <br />~ ., Ma~g Add.ss [ Ph~e No: <br /> <br /> ( ) I ~d~d ~at I must ~s~r as a ~st~a~ c~ ~ ~c s~u~ i~ sold or offend f~ sa~ ~om or n~ ~pl~6~, <br /> <br /> ( ) I wffi ~ my o~ g~M ~m~. <br /> <br />If I him subcontractors, I will him only sub~:ontractor$ resist e, rea~ withithe Construction Camtractors Boar4. If I change my mind and do hire a general contractor. I will contract <br />with a contractor who is mg~st~re.d withe Comtruetion Contractor's BOard, and will imme41ately notify Marion County of the name of the contractor <br /> <br /> ( ) Iamamglstel~dbuild=rORthca°th°rizexlmPmsefitativeofimgisteredbuildet ~ ~j~a~-/~d44, ~KF_, 4"73V' - <br /> <br />Architect name: i .... [ Mailing Ad~l~,: I Phone: <br /> <br />4. Fee Schedule <br />A. VALUATION (See 'Valaation Schedule" <br /> <br />B. Miscellaneous Fees <br /> <br /> to det~rmlne valuation ba~ed e~ <br /> <br /> square footage.) <br /> <br /> (1) P~nnit F~ <br /> (2) 5% Stat~ Surcha~g~ (.05 x Al) <br /> <br /> (3) Structural Plan Review $65% x Al) <br />,)(4) Fire & Life Safety Plan Review (.40% x Al) <br />(5 ' ' <br /> <br />= .R,. <br /> <br />(1) Driveway w/curb @ $7.50 <br /> <br />(2) Driveway w/o curb @ $1 <br /> <br />O) Site Plan Review (commerelal only) @ $79.00 <br /> <br />(4) Additional Plan Reviews or Add~d~as <br /> <br />(5) Investigation <br /> <br />(6) Re, lnsl~ion Fee @ $25.00 <br /> <br />(7) Other Inspections not listed abow <br /> <br />= <br /> <br />I hereby y.emf~, .tgat)he above mformat~on is cor,:ct and that ! have n~ad ~nd understand the Information Notice to Property Owners about Construction Responsibilities on the <br /> <br /> <br />