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I"~OR OFFIC/.p!~ USE ONLY[ MARION COUNTY BUILDING INSPECTION FOR OFFICE USE ONLY <br />R. . ca0 m~ Strut NE ~ -- <br /> <br /> ....... . · . <br /> (~ New Single F~ily Dwelling w/g~e ( <br /> ( ) New S~gle F~ily Dwelling w/o g~age ( ) G~age, <br /> <br />Truss ( ~ or Rafter ( ) I No. Stories <br /> <br />] D.~.tache40stage Height: <br /> <br />fNo. Bedrc~rc~: ~.~ <br />Other: <br /> <br />s,:,,..-,.~,~,, ..,.,,,.,.t: I~,,,.,.~®,,.//TX I:'"°°"""~r: Io".g~, 40'::' <br />2. Loca lion of Installation g.~ 3'0 ~3 <br /> <br />3. Contractor Infovnmtion <br /> <br />( ) I own, r~ide in, o~ will reside inthe ~omplctcd Structure, ~, <br />( ) I understand that I must r~gistrx ~ a oan~tmet, ion contractor ff the strac'ture is ~01d or offered for s~Ie I~fote or upon completion, <br />(~I will b~ my OWtt g~ne~al contra~t or, <br /> <br />' ' ' ,, ' ' , ' 'm]n~....,~ ' y Mahon County of the aamo of the conlracor: <br /> <br />4. Fee Schedule <br />New One and2Two Parn~Iy Dwelling Code <br />(inlcudes El. Me, PO Valuation: <br /> <br />(2) 5% State Surcharge (-05 x Al) <br /> <br />(3) Plan Review <br /> <br />(4) ~ning Sureh~* ($15 if applic~le) <br /> <br />Miscellaneous Fe~a <br /> <br />(I) Driveway w/ourb @ $7.~0 <br /> <br />~) Driwway w/o c~b ~ $17.~ <br /> <br />~) ~ifional ~n g~vi~ws of ~deadu~ <br />(4) Inves~ga~on Fee <br /> <br />¢) Rcia~on Fee ~ $25,~ <br />(6) ~er Ina~s not ~sted a~ve <br /> <br /> x $40 = __ ..... <br />· o'rAc s "'2/~ <br /> <br /> l hcreby eerti£y that thc al:mve info~lllation ia correct and that bavet~ad ndundexstandthelnf~ma~i~N~t~Pr~perty~wneJ~ab~C~ns~ru~ti~nR¢~p~nsibi~iti~n~he <br /> <br /> Site evaluations, septic, electxical, plumbing and mecbamcal work req~re s~rat~ ~r~. Check wi~ M~ion County B~filding I~ion ~fore sub.thug this ~lica~on. <br />MC I5-80 Rev. ID2 <br /> <br /> <br />