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FOR OFFi .~F2~ usE~)NLY MARION COUNTY BUILDING INSP~ECTiON FOR OFFICE USE ONLY <br /> Received'By:~[ ,, ,l :~/ 220 High Street NE <br /> <br />" : F~ 588-7948 <br /> <br />2. Location of Installation <br /> <br />3. Contractor Information <br /> <br /> ( ~l O~, ~S~e ~, or w~ ~sMo ~ ~ completed <br /> <br /> 4. Fee Schedule <br />] A, VALLtATION ($0e "Valuation $ch0~ulo" <br /> to dct~m~nc valuation ~Sea ~ <br /> squa~ f~mgc.) <br /> (1) r~it F~ <br /> (2) 3% S~lc Surchu~c (.03 x A 1) <br /> (3) Stmctu~l Hun Review (.~% X A1 ) <br /> <br /> (4) Fire & L~c SafcW Hah Rcvlew (.~% x A 1) <br /> <br />Valuation: $ ]_~__.~ <br /> <br />(1) Driveway w/curb ~ $7.50 = ____ <br />(2) Driveway w/o curb@ $17.00 = <br />(3) Sit~ Plan P,~-Aew (cOmmercial ~mly) @ $79.(X~ = ~ <br />(4) Additional ~an Reviews orAddendums = __.__ <br />(5) ~v~sfigad~ Fee ~ ~ <br />(6) R~ns~c~m Fee ~ $25.00 = ~ <br />~) O[hcr ~s~ms not ~s~d ~ow - <br /> <br />I hereby conif¥ that tho above informatiOn is correct and that I have toad and understand [he I~formation Notice to Property Owners about Construction ResponsibJJ~ <br />reversesidcofthis form. e, ~ ~ ~ *~r ldf J fi~X~f~ t~t , ~ Ir"/ [ I <br /> <br />MC ~5-?~ ~v. <br /> <br /> <br />