Laserfiche WebLink
FOR O~FIC~,USE OilILY MARION COUNTY BUILDING INSPECTION IFOR OFFICE USE ONLY <br /> <br />Zoni.gVatldation: ~ ' //~_~/~ IFn~t: /t9 ~ .... IRe.r: /tq '~ <br /> <br /> I, Job DescripOou ' ~ ~ ~m"~ <br /> <br />( )Addition ( )Relocation ( )Addition ( )Sign <br />(~Acc~Ss~ ( )~er ( )~a~of~n~ ( )O~er <br /> <br />2. Locationoflnstallatlon ,~d ~,~.S'~///,/,.· eY~-e q'7,~:'-- <br /> <br />3. Contractor Information <br />P~o~y ow~ ..f,~f/~g' ~S .... <br /> <br />If I hire sub~ntractors, I will him only subcontractors registered with the Construaio~ C~ntractor~ Board. If I change my mind and do hire a generel contractor, I will contract <br />with a contractor who is ggismred withe Constmcti~ Contractor's Board, and will immefllatcly notify Marion Caumy of the name of the con~raetor. <br /> <br /> ( ~"~am a mgismmd bo~lder OR ge authorized mWres~nt~tive of a registered bo~dcr, I ~ ~'. ~/~ ~t~, ~V f '7~q ~ <br /> <br />4. Fee Schedule <br /> <br />A. VALUATION (See "Valuation Schedule" <br /> to determine valuation based on <br /> square footage.) <br /> (1) Permit Fc~ <br /> (2) 5% State Surcharge (.05 x A 1) <br /> <br /> (3) StrUctural :nan Review (.65% X Al) <br /> (4) Fire & Life Safety Phn I~view (.40% x Al) <br /> <br />(1) Driveway w/curb@ $7,50 <br /> <br /> (2) Driveway w/o ~urb ~ $I7,~ <br /> <br />~) $i~ ~n R~ew (c~me~ ~ly)~ $79,~ <br /> <br />(4) Addi~ Plan Renews or Add~dom~ <br /> <br />(5) ~ve$~gafion F~ <br /> <br />(6) R~¢a~ Fo~ ~ $~,00 <br />~) O~=r ~s~efi~ not ~smd above <br /> <br />1 hereby certify {hat the above infomaafion is correct and that I have read ~nd under~talld the infomaatien Notice to Propeay Owners about Construction Respc~sibil ties on the <br />reverse side oI this form. <br /> <br /> Site 0valuations. se~c, electrical, plumb~g ~d ~eghunieal wo~ mqui~ se~ra~ ~its. Cheek wi~ Mafi~ County B~ldlng In~eaion ~fom su~it~g this a~lica6on. <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />