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~A~ .................................. MARION COUNTY BUILDING INSFECTION i ................................................... ~ ..... <br />· ~ FOR CITY US~ ONLY..~ ~ - .~ COMMUNITY DEVELOPMENT CENTER i FOR CITY USE ONLY <br />~ P.~cived~y'~.~e~_ Date: ~_~ffr 3150 Lancaster Dr, NE- Suite C i Cit' Setbacks' <br /> <br /> I Pa:cinpt#:~ Amount:$~ 8:00am 4'30,,mllj$l ~'l.~c~<-tl i :~ <br /> . ' ' ' ~"l~.l~ ~lff~l~ Lel~: %/ Right: <br /> ..................................... :4 ~. ~p~. L~e 37~m~s ~ <br /> "FSe / £fi .................................. <br /> ONE AND TWO FAMILY DWELLING PERMIT APPLI~A! ~Oo~' ~/I/I <br /> Dwegillg Ilbnls must be obtaiued at Marion Comity ~nl,~ l=,~e.o, lad m. ~ ~., the~b~ ~l~[p i~,l~cL~for ~lg. ,lectric,I mid me¢~Mdc,I <br /> <br /> ~.~o~ DESC~n'T~O~ - '~/~Rp~.~r ~[~g~ <br />  N~ S~e Fmfly ~ellMg ~ A~ch~ Gm~ <br /> New sin~e Fmily ~ll~g wilh ~ Gmge ( ) <br /> <br />l~tion of Work: .~ ~ 1, ' <br />SquareFootage~]asement: [1 lstFloor: ]~l~ndFloor:' --' <br /> Existing: Proposed: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />() <br /> <br />() <br /> <br />I am thc PROPERTY OWNER and own, reside in, or will reside in tho ~ompleted stm~re and wilt be my ox~n g~neral contractor. I unde~eamd that I must t~ <br />as a cot~ruction ~ootractor if the structure is sold or off~red fo~ sale before or upon ~ompleti~. IfI hir~ subcontractors, I will hire only suin:ontraet~ r~gistc~d with <br />the Construction Contractors Board. Ifl change my mind and do hir~ a genmal contract~ who is regi~ with thc Constru~tinn Contractors Board, I will <br />immediately n~ify Marion County of thc name of the contractor. <br /> <br />I am th~ AUTHORIZED REPRESENTATIVE of the property owner or tile eontraetor. <br />Business Name (please print) <br /> <br />Mailing Address: <br /> <br /> Street City Zip Phone <br /> <br />1 am a CONTRACTOR rcgist~'~d vii~h tb$~tate o.~ey~l, t ~ ~.~ ' ~-J~ ~ ~ <br />Business N~ (pl~ prat): /- ~ ' ~ O~ ~0 ' ~.R~im~m ~:~ <br /> <br /> S~t Ci~ Zip ~ F~ <br /> <br />4. FEES <br /> <br /> VALUATION (Se~ Valunlion Schedule to determine the valuatinn based on square <br /> footage) <br /> LivingArea SquareFeet ]r~~ x $64.66 = $ ~_ <br /> Garage Square Feet ~ x $16.27 = $ <br /> <br /> *************************************************************************** <br /> <br /> A. l. Permit Fee: <br /> Gross Square Feet ~ x ~0'40~0 = $ ~ <br /> <br /> Building ~ $0.185 per square foot <br /> Electrical ~ $0.090 per square foot <br /> M~chanical (~ $0.040pexsquarefoot <br /> Plumbing ~ $0.090 per square foot <br /> <br /> 2. Plan Review Fee <br /> ~l'~5Sqtlal~Fm~L~ X $0ll20/sq. Ft=$ ~ <br /> <br />(I) P~rmit Fcc (A-l) <br />(2) State Surcharge (.05% x A- 1 ) <br />(3) Plan Review Fee (A-2) $ ~ <br />(4) Additional Plan R~viewJAddendum ~ $50/hr, <br />minimum on.naif hour. $ <br />(4) Zoning Surcharge~ if applh:able{-&30:00~" $ ~ <br />(5)InvesligntionFee($.4050pot sq. tL) -- $ <br /> <br />(6) Ro~ctinn Fee, $50.00 $ <br />(7) Inspections made outside of nomal <br />business hours, $50/hr, minimum two hours $ <br />(8) Inspections for wMch no foe is specifically <br />indicated, $50.00/hr, minimum one hour $ <br />(10) Fo~ddation Only Authorization, $25.00 $ <br />(11) Additionnl Sets of Plans $10.00 p~r set $ <br /> <br />I hereby ce~ify flint the above information is cortect, perim~,~r,~ ~b~an~i.$_xp!Lo_ifjyo~ki?not started within 180 ddysofissuanceor ifworkissuslZade'd for 180deys. <br /> Name of Applicant [Please <br /> Mailing Address: ~ 0. -- <br />Stgnature of Applicant ~ <br /> <br /> <br />