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1. JOB DESCRIPTION <br /> <br />RESIDENTIAL <br /> ( ) New ~ Accessory ( ) <br /> Addendum <br /> ( ) Alteration ( ) ReloclCdon ( ) Other <br /> ( ) Addition <br /> <br />Sqaam Foolage: Basement: 1st Floor: /~ O 2nd Floor: <br /> <br />Numhex of Employees: ~ Sea!lng Capacity: <br />2. LOCATION OF INSTALLATION <br /> <br />COMMERCIAL <br />( ) N~' ( ) Multi Family <br />( ) Air.arian ( ) Addendum <br />1~ Additi°n ( ) Sign <br />( ) Crther <br /> <br />( ) Chang~ of O~cuPancy or USe <br />( ) Ma~ufaotu~d Dw~tling Park <br />( ) R~re~tinnal Vehicle Park <br /> <br />Use ofgtructur~: ~o ~ ,~e.//( Occupancy: Enorgy: <br /> <br />Other: No. Stories: Units: Height: <br /> <br />Number of Be. drooms: Existing: Propozed:' <br /> <br />8ubdivialon: ~v-,, ~ ~ [ Lot: Block <br />( ) Mobile Home Park ( ) Mobile Home Subdivision Spa~c #: Total # Spaces: <br />M~: 2-~ O~ zone: ~ P~aS~e:g~/~//~/ () sF () AC U~B: ()Y () $ <br /> Parcel#: I WatorSupply: ~ PfivateWzll ( ) Community Well ~ <br /> <br />CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />1 mn the PROPERTY OWNER and own, reside in, or will reside in the completed s~auctar~ and will b~ my own general ¢omraotor. I understand that I must <br />register as a construction corara~tor ffthe strucaum is sold or offeee<i for sale befor~ or upon oompl~iom If I hir~ subcontractors, ~ will ~ only subcontractors <br />registered with the Construction Contractors Board. ff I change my mind and do hir~ a general conlra~tor who is r~gismmd with tl~ Oonsm:c. fion Conlraoton <br />Board, 1 will immediately notify Marion Courtly of the name of the ~ontraetor, <br /> <br />Buainess Name (plgase Pant) <br /> <br /> Street City: Zip: Phone: <br /> <br />P,~giztration #: <br /> <br />4. FEES <br /> <br />Mailing <br /> <br /> Street City: Zip: Phone: Fax: <br /> <br />A. VALUAIlON (See Valuation ,%hedule to determine the valuation <br />based on squure footage of the project) $ ~000 <br /> <br />(1) Permit Fee <br />(2) State Surcharge (5% x Al) <br />(3) Structural Plan Review (65% x A1 ) <br />(4) Fire and Life Safety Plan Review (40% x ~l) <br />(5~f applicable (6% X AI~ <br />(6) Seismic Surcharge, if applicable (1% x Al) <br /> <br />Miscellaneous Fees <br /> <br />(1) Addl Plan Review / Addendum ~ $501 hr, <br /> Minimum one-half hour <br />(2) Reinsl~ction Fee ~ $50~pur inspection <br />(3) Investigation Fee <br />(4) Inspections outside normal business <br /> Hours ~ $50/hr, minimum two hours <br />(5) Inspections for which no fee is specifically <br /> Indicated ~ $ 50,tm-, minimum one hour <br />(6) Additionsl Sets of Plans @ $10 pex set <br /> TOTAL <br /> <br />I hereby certify that the above information is correct. Permits me non-tramferrable and expire if wo~ is not started within lg0 days of issamnee or if work <br />suspeado:l for 180 d~ys. <br />Name of Applicant [Please Print]: <br /> <br />Phone: x~'g~- -~ /. /__ <br />Signature ofAppli~ant: ./ff~/-~ ~~ Date: <br />MC 15-73 Rev 9/98 <br /> <br /> <br />