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COIxIPLE'I'E ALL SECTIONS, 1 THROUGH ~, <br /> M/kRION ~OUNT¥ <br /> I. Job D~cription .~ G INSPECIlON <br /> <br />Addition ( )R~Jo,;ation ( )AddiSon ( )Sign <br />(~a~as~ ( )~r ( ,)~geof~ ( )~r <br /> <br />Contractor luformatiou <br /> <br /> ) I ov4a. reside in. or will reside in the oompleted ,tincture. <br /> <br /> ) I un~rstand thatl must t~giamr as a ¢onStmaficau contractor if the stmetmu is sold or offered for sale before or upon completica. <br /> <br />4. Fee Schedule <br /> <br />A. VALUATION (~ue '+Valuation $chexlala" <br /> to detaffnlne valuatlon bag~d oll <br /> squ~ <br /> <br /> (1) Peril F~ <br /> ~) 5% $~ Surcha~e (,05 x A 1) <br /> ~) Stn~cmr~ Phn Rev~w 6~% x Al ) <br /> (4) Fire & ~fe Safety Plan Rev~w 6~% x Al) <br /> (5) ~~.~~ A I) <br /> <br />lvllsee.llaneous <br /> <br />(1) Driveway w/curb@ <br /> <br />O) Site Plan Renew (c~m~hal ~ly) $ $79.~ <br />(4) Addifi~al Plan Renews et Add~dvm~ <br />(5) ~sfiga~ Fee <br />(6) R~s~efi~ <br />~) ~er ~s~c~s not ~sted abo~ = <br /> <br />/ horeby certify that the abov~ itfformafion is correct and that { have read and understand the Inforlnation Notlee to Property OWners about Construction Responsibilities on thc <br /> <br /> .qit~ evaluations, septic, ~lcctrical, plumbing and muchanic~l work ruqalr¢ s~p~mta permits. Chuck ,.viii: Mafim~ CoOnty Building In~p~c'clon bt:fern ~ubmitfing this apphcafion. <br /> <br />MC I~-73 Rev. 11/91 <br /> <br /> <br />