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Zoning Validatiqs: '~o'_ f.J ~ · <br />lOa~: 'f-/~- -9''5 / <br /> <br />MARION COUNTY BUILDING INSPECTION / FOR OFFICE USE ONLY <br /> 220 High Street NE . ~ r~ 1[~i[17¢"$'e1~"~[[~equirements: ' <br /> <br /> BUDDING PERM~ APPLICATION <br /> <br />COMPLETE ALL SECTIONS. 1 THROUGH 4 ~RI01q C0Ulq~ <br />L Job Description ~jl~.~)~~ I~D~'~0~ <br /> <br />RESIDENTIAL COIVLMERCIAL ( )New Useof Structure: <br /> ( ) Demohfim ( ) Atmration ( ) Demolition <br />( ) Alteration <br /> (~Acces~ow ( )O~er ( ){~ange of Occupancy ( ) <br /> <br />'l'n,,~ ( ~( or Rafter( ) I No, Stofio~ / [ aCtUate l,~d or Number of E~ployees Nv, Bedsores:' '~ <br /> <br />Location of Installation <br /> <br /> qv -TA ' ',"' '"75] ........... / ............. _ <br />Mobile Home Park S~ce ~ <br />Sectk,nff~ //~i ~bms~p ~S Rang, 2~ ............... Z~¢ /d:2 Map Water Supply: <br /> , ' PrivateWell ( ) Spring ( ) <br />LotWidm ~ LotDepth /fid r Acres Irreg. t~t ~ Comer ~O Communib'Well( ) City ¢..p <br /> <br /> Contractor Information <br /> A4 Az/ .... <br /> ) I own, m~ide ~, ~ ~ reside in the completed structure, <br /> <br />({ ~-1 wlH be my om gcmeral contmcton <br /> <br />-?,/¢ -/j2c~--. <br /> <br />If I him subcontractors. I will hire only ~ubcontractors regbtered with the Constmclion Contra¢lors Board, Ii- l cbs,Igc my ~lxind and (ltl hire a general contractor, i will contract <br />with a contractor who ia registered withe Construction Contractor% Board, and will hnmediately notify Marion C~unIy or <br /> <br />Fee Schedule <br /> <br />A. VALUATION (See "Valuatkm Schedule" <br /> <br /> square footage,) <br /> <br /> (1) Permit Fee <br /> <br /> (2) 5% State Surcharge (.05 x Al) <br /> <br /> (3) Smlcmral Plan Review (.65% x Al) <br /> <br />(1) Diivcway w/curb (c~ $7,50 = -- .......... <br />(2) DrNeway w/o curb (~3 $17,00 <br />(3) Site ~ lan Review (commerchfl only) (i_b $79 00 <br />(4) Additional Plan Reviews or Addendums = __ <br />(5) Investigation Fcc = _ .......... <br />(6) Reinspecdon Fee ~ 525.00 ~ .......... <br /> <br />I hereby certify that thc above information is correct and that I have read and understand the Information Notice to Properly Owners aborn Conslnl¢6on Responsibilities otl thc <br />reverse side of [his form. <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />