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FOR 0FFIC~ USE ONLY~ <br /> Received By: [J~. ~ ~/-g~°~'I <br />Izoni. Vali on/Z __Z¢= I <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High St~i'~1~ ~ <br /> <br /> BUILDING PERMIT APPLICATION <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 {~$[at~ COUNTY <br />I. Job Description ~I},~tN(~ tNSPECIION <br /> <br />FOR OFFICE USE ONLY <br /> <br /> Rear: 1~ <br /> <br />~ghz Side: <br /> <br />2. Location of Installation <br /> <br />JobAddmss /~' ~r~ TaxAcct. No. ~aO~O.$-lO Cro~sStr¢et~M~.~ <br />Mobile l-I~e Pa~ Spat* ~ <br /> Se~ionSff~p ~S'~;nshlp ~ Rangd" ~ ~e ~0~ Map W:~'r~upply: <br /> .... PfivateWell ( )Spring <br /> ~Wldm ...... ~/ Lampth /~t Acma I~eg.~t Comer ~5 Communil> Wen( ) City <br /> <br />3. Contractor Information <br />I'ro~nyOwner ~ff.Z~)~C ~.~,.2'J'~/~.//~). ...... IMaiithgAddres* ~.~d~ ~7 1Pb°noN°; <br />( ) I om, m~idc in, ~ wffi ~side <br /> <br /> (~ I wifl be my own gmeral <br /> <br />Contractor Buathc~ mmae & #: [ Mailing Address: ]Phone: <br /> <br />4, Fee Schedule <br /> <br />Or-e. <br /> <br />A. VALUATION (See "%Iuatio~ Schedule" <br /> to determine vaMatiotl based on <br /> square footage,) <br /> (1) Permit Fee <br /> (9) ~% Slate Surcharge (.05 X Al) <br /> <br /> (3) Structural Plan Review (.65% x Al) <br /> <br /> (4) Fire & Life Safety Plan Review (.40% x Al) <br /> (5) Zoaing-.%r=':::~pl/cable (.05% x A l) <br /> <br />Valuation: $ <br /> <br /> Sbt <br /> -- /. <br /> <br /> (1) Driveway w/curb @ 57,50 <br /> <br /> (2) Driveway w/o curb @ $17,00 <br /> <br /> (3) Site Plan Review (commerelal truly) @ $79,00 <br /> (4) Additional Plan Reviews or Addcndums <br /> (5) Investigation Fee <br /> <br /> (6) Remspeetion Fee @ 525.00 <br /> (7) Other bzslyecfions not listed above <br />RE:CEiPT:. <br /> <br />1 hereby ccaify that the a~ov¢ ilfforrnation i~ correct and that I have read and understand the Information No,ice to Property Owner~ abe i C ms rt erie Re~peaxsihililies on the <br /> <br /> She evaluations, ~epti¢, eleclfical, ~umbthg and in¢chanical ;ork requite seperate permits. <br />MC 15-73 Rev. 11/9I <br /> <br />Cheek with Marion County Bu/Idjng Inspection before ~ubmJuing this application. <br /> <br /> <br />