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~OR AT/IONI <br /> ~ITY VALID MARION COUNTY BUILDING INSPECTION <br />',~ ~ COMMU~TY DUVELOPM~rr c~rrEU <br />[Rec.~ivedB: 285 Church St. NE- Room 132 <br /> <br /> g Validati 8:00am-4:30pm Phone 588-5147 <br /> <br /> ONE & TWO. FAMILY DWELLING PERMIT APPLICATION *lnclu ' ' ' <br /> <br />1. JOB DESCRIFrlON <br /> '~New Single FamilY Dwelling With Attached Garage FEB 2 <br /> ( ) New Single Family Dwelling With Detached Garage <br /> ( )~,,,mp~ MARION COUNTY <br /> 131111 ~IMD IM~DI::t?TIt31~I <br /> v' "?3 ...... <br /> <br />IFOR CITY USE ONLY <br /> <br />City Setha~k R~quirements: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION ~ PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />I am the PROPERTY OWNER and own, reside in, or will reside in the completed structure and will be my own general contractor. I unde~tand that I mus~ register as a consh'uction <br />contractor if the s~ucture is sold or offered for sale before or upon completion. If I hire sobeonlxaciors, I will hire only subconlractors registel~l with the Constn~ion Contractors Board. <br />If I change my mind ami do ~ a gem~l contractor who is registered with tbe Construction Contractors Board, I will immediately notify Marion County of the nmne of the cona-aettw. <br />Busis~ss Nam~ Registration No. <br />[~,,.~r~ ~'r'~.~ ~--~.e,,---~) /o .~o o 1 <br />I am en AUTltOlllZIr'~ RIgPRIi'-~F-aNTATIV~'-' ° f th~ im~lY°~r °r c°ntr~m'- <br />Phone <br /> <br />4. FEE SCHEDULE <br /> <br />VALUATION - Based on square footage: <br /> GrossSqFt I~;O x 64.66 <br /> Oara~SClfl t~"~ x 16.27 <br /> TOTALS: <br /> <br /> C_nn:~ Sq Ft <br /> · Building <br /> <br /> Mechanical <br /> Plumbing <br /> TOTAL <br /> <br /> 2. PLAN REVIgW <br /> <br /> Gross Sq Ft <br /> <br />5. <br /> <br />6. <br /> <br />7. <br /> <br />8. <br /> <br />PERMIT Fgg~ <br /> <br /> State Surcharge (5% of A-I) =S <br /> PI~ R~i~ F~ (A-2) . =$ ~.~ <br /> <br /> Inv~fi~fi~ F~ ($.345 ~ ~ ~) ~ $ <br /> Re~ F~ $25.~ ~ $ <br /> ~ ~ ~.~/~r ~ (1 ~.) <br /> ~ i~fi~ ~.~'~ (2 ~ ~) ~ $ <br /> <br />Dwelling labels must be obtained at Marion County Building Inspection and must be placed at the jobsite prior to inspection for plumbing, electrical and <br />mechanical work. Contact Marion County for instructions. <br /> <br />I hereby ceflify that the above information is correct. Permits are non-transferrable and expire if work is not started within 180 days of issuance or if work is suspended for <br />180 days. ,~ <br />Name of Applicant (Please Prin0: ~ ~.-~. ' ~'Z C~J:~"~3/~x- t Phone: ~ '~ 3 ~ O 3 9 <br />Signature of Applicant: Datc: o~ ~ ~(o <br /> <br /> <br />