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FOR OFFIC .~ USE ONLY MARION COUNTY BUILDING INSPECT~,~JFOR OFFICE USE ONLY <br />Received B · /~,--~ q ~ ~ <br /> Y. ~., ..... ~0 High S~t <br /> <br /> gh <br />~-- FAX 588-7948 <br /> BUmDmG PERM~ APPLICATIO~ ~Z <br />CO~ ~L SECTIONS, 1 T~OUGH 4 <br /> <br />2. LoeationofInstallation ~,~. ~/J~I/e~, fl6 q¢--~' <br /> <br />Contractor Information <br /> <br />( ) I own, re*ide Jrt, or w~l reside in <br />( ) l undentand/hat % must t~glst~r as a construction contractor if/he atme~ure ia cold or offered for sale befoi~- or upon cc%repletion. <br />( ) I will be my own general contractor <br /> <br />IfI him subcontractors, I will hi~ only $ub¢ontractoi~ registered w~th thc ¢onst,rllmfion Cmt. raetors Board. IfI change my rcdnd and cio hire a general contractor. I witl contract <br />with a contractor who ix regist*rcd withe Cons~metic~ Contrae~,~l immeglate, ly notify Marion County of the name of/he ¢ontxaetor, <br />Con ra~tor Business name & #: ~ 6 Mailing Address <br /> ( ) Iama~gi~te~dbttild~rORtheauthofizedrepr~s~ndtiveofai~giateredbeiMe, ~d~.4, /~r~ ~v ~, ~,~,v <br />Archlteet name: [ Mailinll Address; [Phone: <br /> <br />4. Fee Schedule <br /> <br />A- VALUATION (S~e"Valuation Se. he, dale" <br /> to determine vainatio, based on <br /> square fontage,) <br /> (1) Permit Fee <br /> <br /> (2) ~% Stat~ Surcharge (.05 x Al) <br /> <br /> (3) Structural Plan Review (.65%xA1) <br /> (4) Fire & Life Safety Plan Red*w (.40% x Al) <br /> <br />Valuation: <br /> <br />B. Miscellaneous Fees <br /> (I) Driveway w/curb @ $7.50 <br /> <br /> (2) Driveway w/o curb @ $17.00 <br /> <br /> (3) Slte Plan Review (¢ommemialonly)@ $79.00 <br /> (4) Additional Plan Reviews or Addendems <br /> ($) Investigation Fe~ <br /> <br /> (6) Re/n~peetlon Fee @ $25.00 <br /> (7) O/her~n~¢tion~ not llsted above <br />RECEIi~I':_~ ~ <br /> <br />I hereby certify that the above infomaat[on is correct and/hat I have mad and understand/h~ Information Notice to Property Owners aborn Constmctinn ResporlslbLl/ties on the <br />reverse side of this form. <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />