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FOR OFFiCE, USE ONLY I MARION COUNTY BUILDING INSPECTION <br />Received By: - f%-~ :~ '~- 220 High SUeet NE <br /> <br /> BD~D~G ~RM~ APPLICATION <br /> CO~L SECTIONS, 1 ~OUGH4 ~ARION COUN~ <br /> 1. Job Description BO[~Ol~6 [NSPEGTION <br /> <br />Location of Xnstanatloa ~ ~ q Z.~75- <br /> <br />3. Contractor Information <br /> <br /> ( ) I own. ~ide ia; or will mslde in the completed ~tmoture. <br /> ( ) I understand that I must rcgismr as a construction cc~tra¢~t- if ~he sUuaum is sold or offend for sale before or upon ~mpletlon, <br /> <br /> ( ) Iwlllbemyowllg~let~l¢ontrac'tor, <br /> <br />H I l/re subcontractors, I will hire ~nly sub¢on[xact~ mgister~l with the Construction Clmtractor~ Board, If I change my mind and do hlr¢ a general contractor, i will COntract <br />with a ¢ommetor who is mglsteted withe Comtmctic~ Contractots Board, and will ~mm~iately nOffy Marion County of the name of the contractor. <br /> <br /> (~,~! am a ~gismred builder OR the authorized r~p~s~nmilv~f a mgistea~d builder, <br /> <br />4. Fee Schedule <br /> <br />A, VALUATION (See "Valuation Schedule" <br /> to determine valuation based <br /> ~quare footage,) <br /> (1) Permit Fe~ <br /> <br /> (2) 5% State Surchaege (.0,5 x A 1) <br /> <br /> (3) Structural Plan R~view (.65% x Al) <br /> <br /> (4) Fire & Life Saf*ty Plan Review (.40% x Al) <br /> <br />t <br /> <br />B, iVllsce, llane~s Fees <br /> (1) Drivcwgy w/cuffo @ $7.50 <br /> (2) Driveway w/o cu~ <br /> <br /> (4) Addldonal Hun Radews or Add.dins <br /> <br /> (5) ~vesfiga6~ <br /> <br /> (6) R~s~efi~ F~ ~ $25,~ <br /> ~) O~r ~s~cfims not ~s~ above <br /> <br />I hereby cenff that the above information is <br />reverse side o~this form. oorre~t mud that I have read and undemand thc Irdorr~ation Notice to Properly Owners about Construction Responsibilities on the <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />