Laserfiche WebLink
COMPLETE ALL SECTIONS, 1 THROUGH 4 MARION COU NTY <br />1. Job Description BUILDING INSPECTION <br /> <br />RESIDENTIAL COMMERCIAL ( ) New Uac~ofd$jmeture:of meture: <br />)Addition ( )Relocation ( )Addition ( )Sign <br /> <br /> ?~itemfion ( ) De, tttolitic41 ( ) Alterafloa ( ) Dcmothlcn <br /> <br />([dfAcce~cay ( )Other ( )CllangeofO¢cupancy ( )Other <br />..:::::: ' ¢' ' .... . ...... <br /> . · t Occupant Load or Number ~f Empinycc~ No, ,Bhcdrooma: ......... <br />Sque*I~-Poet; Ila,~inent: I ~'d,{a~,~,: ' I S.~..~O0,1'"': ..... I Oth,.! ,3'~o .... .,~.h,: Z ~, ,,,, <br /> <br />2. Location ol Mstallafion · ~] 7~ (c~ <br /> <br />Subdivision L~ Bilk <br /> Private WeJl ( ) Sp~ng ( ) <br /> <br />3, Contractor Information <br /> <br /> ( ) I own, reside in. or will reside in the compl*~d s~m~ure. <br /> <br />If I h re subcon tatters, I will h m only subcontractors registered with the Constmcdon Comtactovs Board. ff ! change :ny mlnd and do t~"o a genera r contractor, i will Contract <br /> (~/"Y ama registered..,, bu&tder OR the authorized rdpresen.tivc ~a <br /> <br />4. Fee Schedule <br /> <br />A, VALUATION (See "Valuation Schedule" <br /> <br /> square <br /> <br /> (I) P~nni~ Fee <br /> (2) 5% State Surchaxge (.05 x Al) <br /> <br /> (.3) Structural Plan Review (,65% x Al) <br /> (4) F{m & Life Safety Plan Review (.40% x Al) <br /> <br />Valuation: <br /> <br /> (1) Driveway w/curb@ $7.50 <br /> <br /> (2) Driveway wig curb @ $17.00 <br /> <br /> C3) Site Plan Review (cornmcreial only) @ $79.00 <br /> <br /> (4) Additional Plan Reviews or Adddndums <br /> <br /> (5) Investigation Fcc <br /> <br /> (6) Reinspcctk, l~ Fee@ $25,00 <br /> <br /> (7) Other Insl:ej~rionl not listed above <br />we.nm: q'~'7~2 <br /> <br />I hereby ~erti.f¥ Il!at the above information la, correct and that I have read and Understand the I~format{oa Notice to Property Owners about Ccd s ru¢tio Reapc~slbJh les on the <br /> <br />s,,.,,,., o,^p,ll..,,. >¢¢¢_~.%:,/¢.~.~: : ,, ', ' ' ;,2'7' -7~?~/¢ ~" ...... <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />