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FOR OFFIC~ USE O~NLY <br />Received By: ,[~'~.) 4g/~ <br />[Zoniag Validation/' ff~ q' <br /> <br />MARION COUNTY BUILDING INSPECTION IF~OR OFFICE USE ONLY <br /> <br /> 8:00am - 4:3~m Ph}~8-$147 ~ ~gt S~e; /O / ~ mgm Side; ~W z <br /> <br /> BUILDING PERMIT APPI~{~i N~ ¥I <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 BUILDING INSPECTION <br />1. Job Description <br /> <br />2. Location of Installatlon <br /> <br /> ¢7.s2S ' ............... <br />Subdivision Lot Bilk <br /> CommunityWelI ( ) City <br /> <br />3. Contractor Information <br />Property Owner ] Mailing Address I] Phone No: <br /> <br />own reside in or vdll reside ~ thc completed structure. <br /> <br />will be my oven g~aer~l contractor, <br /> <br />( ~ am a registered builder Og ~* a~ori~d ~s~mfive of a registered ~ld0r, ~/4 m/ D r ~ q 7 Xo5 <br /> <br />VALUATION (See "Valuation Schedule" <br /> <br />to detcrmlne valuation based on <br /> <br />square footage.) <br /> <br />(1) Permit Fee <br /> <br />(~) 5% State $orchaege (,05 X A I ) <br /> <br />(3) Structural Plan Reviow (,65% x Al) <br />(n) Fir* ~Vhln Review (,40% x Al) <br />(5) Z'~r!i , ' ' %!: ~-za°t~o x Al) <br /> <br />B. Miscellaneous Fees <br /> (l) Driveway wleukb~o) $7 50 <br /> <br /> (2) Driveway w/o curb @ $17,00 <br /> <br /> (3) Site Pla~ Review (eommemial only) @ $79.00 <br /> <br /> (4) Additional Plan Reviews or Addendmns <br /> '(~) InVestigafim Fee <br /> <br /> (6) Remspecfion Fee @ $25.00 <br /> (7) Other inspections~ n~[ listed above <br /> <br />'rm,~L s ~& 7, ay <br /> <br />I hereby certify that thc above information is correct and that [ have mad and undcr~tand the lllformation I'qotice to Proper~y Owncr~ about Conatmction R~3sponsibilid~s on the <br />mwr$e aide of this forrn~ <br /> <br /> , ~.D Date: <br />Site =vmuadons. septic, eleCtS;, plumbing ~d mcchanlcal wo~ mqui~ sc~ra< ~its, Ch~ck wi~ Marion County Building lnspeaion ~fo~ ~ubmitting ~is app~cation. <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />