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"?OR OFFICE USE ONLY I <br /> <br /> Zoning. Validation: _ ._ I <br />IDate: /d -~ ~- 9~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> <br /> 8;00am - 4:30pm Phone 588-5147 <br /> Code-A-Phone 588-7904 <br /> FAX 588-7948 <br /> BUILDING PERMIT APPLICATION <br /> <br />FOR OFFICE USE ONLY <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 MARION COUNI¥ <br />1. Job Description C) BUILDING iNSPECTION <br /> <br />RI~SID ~EaN'rIAL coMMercIAL ( )New U~e of Structure: <br />( )Addition ( )Relocation ( )Addition <br />( ) ~tcrafion ( ' ~O~fim ( ) Almmtion ~Dez~o[/tion <br />( ) AcC~Ss~ ( )~ar ( )~ange~Occu~ncy ( )O~Cr <br />Descdpaon ofWo~: c~ ~ ~~ <br />'r~( ) o~ a~ft~( ) [ Ne. Stories/~ [O~u~ntL~dorNumber~ploy~es Ne. Bedrooms: <br /> <br />2. Location of Installation <br /> <br />[ .............. ~ PfivateWell ( ) $ptiag ( ) <br /> <br />3. Contractor information <br />,P,r. openy Owner _ - ~m~'~ cCC ~ .~V z/O TMa~Add~- <br /> ( ) I o~, reside m, orw~ reside ~ the completed simian, <br /> <br /> ( ) i un~ls~ad ~at I must re~stel as a construction coBtractor Jf ~e *tmaure ix sold or offered for sale before <br /> (~wi~ be my own gmeral contractor, <br /> <br />If I hire subcontractors, l will hire only subcontractor~ registered with the Construction Contractor~ Board. I£ t change my mind and do hire a general contractor, I will contract <br /> <br />Archilect name: [Mailing Address: l Phone: <br />4. Fee Schedule <br /> <br />to detem~e valuation based ~ <br />square f~tag¢,) %luation: $_~ <br /> <br />(I) Pem{t F< <br />(2) 5% State Surcha~e (,05 x Al) = , ~ <br />(3) Structural Plan Review (,65% x Al) = ,~ <br />(4) FiT & Life Safety Plan Review (.~% x Al) = ,~ <br /> <br />B. Miscellaneous <br /> (1) Driveway w/curb @ $7.50 <br /> <br /> (2) Driveway w/o curb (~ $17,00 <br /> <br /> (3) Site Plan Review (commercial only) @ $79,00 <br /> <br /> (4) Additional Plan Reviews or Addendums <br /> <br /> (5) Investigation Fee <br /> <br /> (6) Reinspection Fee (~/$25.00 <br /> <br /> (7) Other In/qpections not lj~ted above <br /> <br />TOT~L $ //v-o <br /> <br />hereby cedi fy tl}a~the above i~ffonnafion is correct and that I have read and undetshand ~e ~fo~atlon Notice to Propeny Ow~ers about C(mstmctJo,~ Respoaslbilifies o0 the <br />reverse side of this fo~, <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />