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MARION COUN2:/H~hU~L2fN2 I~SP~EC~TI?~N~ ~,~ONL_Y ! <br /> BUll,DING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 TH:ROUGH 4 MARION COUNTY <br />1. Job De~rlptlon BUILDING INSPECTION <br /> <br />RESID .EN'rlAL COMMERCIAL ( "i New I U~e of Structure: <br /> ( )Addition ( )l~-eloealion ( )Addition ( )Sign <br /> <br /> ( ) Alteration ( ) Deinolltim ( ) Altefa~m ( ) Demolition <br /> (~ccessory ( )Olher ( )ChangeofO¢¢~lpaney ( )Other <br /> <br />Tru*sS~)/ or lC, after( ) I No. Stofie,w t' .... 'l'O¢~lpa~tLoedorNumber~lfip!oyez$ <br />Square Feet: ...... ea~eltleta: [ MaJi~ Fioo[i,,' Is¢c~tld FlOOr: ,,, Imcr; <br /> <br />2. Location of] ngtallatio. ~bh, ~ q 7~'f~ <br /> <br />3. Contractor Information <br />Pr°l~tY Own~iJ~ .~.p~. ' 't~.O~.~~ I Ma~ng Address I Phone No: <br /> <br />( ) ~[ own, reside in, or wJJl l~sicle in file completed <br /> <br />(; ) I undemand that I muss register as a ¢onstmclion conuactor ff the stauemre i~ ~old or offered for sale before or upon eompletim, <br /> <br />( ) I will be my own g~cml contractor. <br /> <br />If I h/re ~ube, ontmet~rs. I w/Il hire only *ubconttactor~ rcgixtcred with ihe Construction Contt~gwrs Board. Ij'I change my mind and do I~rc a general contractor, 1 will contract <br /> <br />with a contractor who i~ registered withe Comtmcfion Coatraetor's Board, ~nd wR1 intmediately notify Marion County of the name of the contractor. ~'~ ~ <br /> / <br /> 7 <br /> <br />4. Fee Schedule <br />A, VALUATION (Se~ "Valaation Schedule" B. Miscellaneous Fees <br /> <br />i0 determine:valuation based <br />square footage,) <br /> <br />(1) Permit Fee <br /> <br />(2) 5% State Surcharge (.05 × A 1 ) <br /> <br />(4) Fire & Dfc Safety Plan Review <br /> <br />(1) DriVeway w/cu~ @ $7.50 <br /> <br />(2) Driveway w/o curb @ $17.00 <br /> <br />(3) Site Plan Review (commercial only) @ $79.00 <br /> <br />(4) Additional Plan Rev/ews or Addendams <br /> <br />(5) Invesligatlon Fee <br /> <br />(6) Retnspe~ca Fee @ $25,00 <br /> <br />(7) Other Inspections not listed above <br /> <br />TOTXI. $ <br /> <br />[ hereby certify that the above lidormation i~ curlier and that I have mad and undemtand the Information Notice to Property Owners about Construction Responsibilities on the <br /> <br />MC 15:/3 Rev, 11/91 <br /> <br /> <br />