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FOR OFFIC]~ US~ <br />Received By: (..L~Lr ffff. g6~. <br /> <br />Date:~ ~ <br /> <br />MARION COUNTY BUiLDiN~G INSPECTION iFO~ OFFICE USE ONLY <br /> 22011igh Street bl~j .. .[~ ,~ g~ ~t~ ~Req~ts: <br /> <br /> 8:~ - 4:3 ~e 5~-~7 ~e ~t Side' i <br /> BUmD~G PERM~ APPLIC~ C0U NI~ <br /> <br />COMPLETE ALL, SF.,CTIONS, 1 THROUGH 4 BUILDIN(3 INSPECTION <br />1. Job Description <br /> <br />RI~SIDBI~I'IAL COMMF~RC&a.L ( ) New U~e of Structure; <br />)Addition ( )R~location ( )Aa~ition ( )Sign <br />) Alt~,~tion ( )r~dlc~o. ( )A~arion ( )r~olltlon <br /> <br />2. Location of installation <br /> <br /> 3. Contractor Information <br /> <br /> ( ) Iown, msidein, orwillresldcLntheeompletedstmaure. ,:;, <br /> <br /> ( ) I understand that I must register as a constmetie~ eonmetor if the structure ;~ sold or offered for sale be. fore or upon eomplctinn. <br /> ( ) I will be my own gmaeral contractor. <br /> <br /> If I Mre subeontractom, I will hire only subcontractors fegistexed with thc Constmctica~ Contractom Board. If I change my mind and do t~rc a general contraCtor, I will contract <br /> with a contractor who is registered withe Congtruedm Contractor's Board, and willimmedia~ely notify Marion County of the name of the contraeton <br /> <br /> (tdfflamaregisteredbuilderORihoautholSzedrepresenta~fivcofamgistemdbuflder. J~.~.t..L,~/~ (/7.~0 ~ <br />' :lM s*ti =s::'1Pb° e: <br /> <br />Fee Schedule <br />VALUATfON (See "Valuation sched~i~- <br />to detcrmln¢ v~luation based on <br /> <br />square footage,) <br /> <br />(1) Permk F~ <br />(2) 5% Sta~e Surcharge 605 xA1)' <br />(3) Slmemral Plan Review (,65~ x Al) <br /> <br />(4) Fire & Life Safety Plan Review (.40% x:AI) <br /> <br />' "' B; Mi~¢elianeou~ Fees <br /> · (1) Driveway yt/eurb@ $7.50 <br /> ~2) Driveway w/~ curb @ <br /> <br /> , .',: (3) Si~ePhnRevlew(comntemial only)@ $79.00 <br /> (4) AddiQonal Plan Review~ 6~Addmdums <br /> (5) In~stlgatim Fee. <br /> "(6) Rein~peeti. on Fee @ $25.00 <br /> (7) Other/ns~ctie~s not listed above <br /> cmr: q¢37 <br /> <br />TOTAl. S <br /> <br />I hereby cenlfy that thc above information is ¢oetect and thai I have read and ~nderstand the Infofmadon Noficb to Property Owner~ about ComtmcQo I Responsibilities on the <br />mvemc side of this foml. <br /> <br />S n ,u oI^pplic n,: ....... <br /> / ./ <br /> / <br /> Site evaluations, septic, electrical, plumbieg and mechanical work require scperat~ permits. Check with Marion Co0my Building Inspection before ~ubmitting this ap~l/cafion. <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />