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FlY-.OR CITY VALIDATION <br />[Re'ceive.d By: ~ <br />[Zoning Validation: ~ <br />IDate: ~' <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. JOB DESCRIPTION <br /> <br />MARION COUNTY BUILDING INSPECTION FOR CITY USE ONLY <br />COMMUNITY DEVELOPMENT CENTER <br /> <br /> 8:00am-4:3Opm Phone <br /> <br /> BUILDING PERMIT APPLH A~OpN <br /> <br />RESIDENTIAL <br /> <br /> ( ) Addition ( ) Relocation <br /> ( ) Alteration ( ) Other <br /> ( ) Accesso[y <br /> <br />COMMERCIAL "~t/[t~ <br />~ddifion ( ) New <br />( ) Alteration ( ) Sign <br />( )ChangeofOccupancy ( )Other <br /> <br />S~. f~SquamFootage-Basement: ~ Main~oor: 3 S~ondFinor:SecondFinor: ~ <br /> <br />2. LOCATION OF INSTALLATION <br /> <br /> Mobile Home Park <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />Water Supply: <br />t~ivate We~ ( ) spnng <br /> <br /> Phon~ <br /> <br />4. FEE SCHEDULE <br /> <br /> A, VALUATION (See "Valuation Schedule" to d~termlne valuation based <br /> <br />on square footage of project.) <br /> <br />(1) Permit Fee <br /> <br />(2) 5% State Surcharge (.05 x Al) <br /> <br />(3) Slmcmral Plan Review (.65% x Al) <br /> <br />(4) Fire & Life Safety Plan Review (.40% x Al) <br />(5) Zoning Surcharge, if applicable (.05% x Al) <br />(6) ~eismic Surcharg~ <br /> <br />B. Miscellaneous Fees (1) Additim~al Plan Reviews or Addealdums <br /> <br /> (2) Investigation Fee <br /> <br /> (3) Reinsp~etion F~ @ $25.00 <br /> <br /> (4) Other Inspextiom not listed above <br /> <br />=$ <br /> <br />TOTAL <br /> <br />I hereby certify that the above information is conect. <br />Permi@ are non-transferrable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. <br /> <br />Name of Applicant (Please Pfin~ .Phone: <br /> <br /> <br />