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Recei?d By: ~' <br /> Zonis~ Validatiorff ~ x~p <br />lr, ,i <br /> <br />MARION COLINTY BUILDING INSPECTION IFOR OFFICE USE ONLY <br /> 220 High Str~l NE.. -- _l. City Setback Req/drements: <br /> <br /> BumDING pERM~ APPgt~ATI6N ~ <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 MARION COUNTY <br />1. Job Descrlption BUILDING INSPECTION <br /> <br />! RESLD/SNTIAL COMMI~RCIAL ( ) New Use of Stmetu~: <br />( )Xddi~O~ ( )R~l~ation ( )Addition ( )Sign ~/~ ~ <br />(~cc~sso~ ( )~er ( )Chang~ofOccu~ne7 ( )Omer <br /> <br /> Tress( ) or Rdmr(~ l,,,~o-Stode$ / , moccu~ntLmdorNux~ber°fEmpl°yeec mN°'Badr°°ms:~/~, <br /> Square ~[: Basement: [ M~ ~mr: ~ ~ I S~d B~r: ...... ] ~her: ~ Ilei~t}" /~ t ~' <br /> <br />2. Location of Installation <br /> <br /> ,, PdvateWel[ ( ) Swing <br />Lo, Depth ~,:,,~ Acres .......... I~eg.~t~ Comer, ....... ~ S Comm ,n ...... yWca( ) City <br /> <br />3. Contractor Information <br /> <br /> (~ I own, reside in, or wm reside gthc completed stmctu=. ~a mWO ~//e , ~r~ <br /> ( ) I andersmnd that I must mgismr a8 a con*tmeUon contractor if ~e stmcxu~ is sold of offered for sale before or <br /> ( ~ wBI be my own gmeral contractor, <br /> <br /> ( ) I am a registered builder OR the authorized representative of a registered builder. <br /> <br />4. Fee Schedule <br />A. VALUKi~ON (See "Valuatloa Schedule" B. ~sc~aneous Fees <br />to detc~ine valuation N~sed ~ (11 Driveway w/curb ~ $7,50 <br />square f~tage.) ¢) Ddveway w/o curb Q) $ I7,~ = <br />(I) Pennd F~ (3) Sim ~lan Review (commercial o.ly) (~ $79.(Xl = ......... <br />(2) 5% Sram Surcha~e (.05 x Al) (4) Additional Plan Review~ or Addendmns = .......... <br />(3) Sm~cturat Plan Review (.65% x Al) (5) ~vu~gatio~l l:ee = -- <br />(4) l;im & Life gaf et7 Plan Review (.40% x Al) (6) geins~cfim Fee ~ $25,00 = .......... <br />(5)~,~.ifa~xAl) ~'~ O) O~erlns~ction~not~ted above = ~ <br /> <br />Valuation; $ J'~4/~'~ <br /> <br /> = <br /> <br />i hereby Ce. fl Jf'y that the above informatiOn is correct and lhM ~ have read and understand the In fo~matioll Nolle¢ to ProperLy Owners about Construoliorl Respo~/sibilhies on the <br />reverse,side of'Ibis form. <br /> ,' ' <br /> .... ' <br /> Silo evaluations, mptic,,~eotrl~l, plurnt;ing and mechanical work require ~eperate Ilermi~s. Cheek with Markm (2ounty Building In~peebon I<l'om ~ulmaitting this application, <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />