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FoR'OFFICE USE ON~Y/ <br />[R¢ceized By: ;/51r;~ 4 /~x.~fl <br /> <br />MARION COUNTY BUILDING INSPECTION ~CE ~____~E O~NLY <br /> 220 High $~-eet NE city Setback R~q~awm~..: <br /> 8:00~-4:3~mPhone588-~ i ~ ~ ~ <br /> BUmDING PERM~APPLICATi~ '~ ~ 1995 MARION O0~NTY' <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. Job Description ~lJ!kBIt, l~t IN~[ ~TION <br /> <br />RESIDENTIAL ' ...... COMMERCIAl." ( )~e~v~~ ' Use of Stradture: <br /> <br /> ( )Addition ( )Relocation ( )Addition ( )Sign ~"O /~//'~- ~t~n'~ <br /> ( )A~essoW ( )~cr ( )~angeofOccupaney ( )O~er <br /> <br />'I'mgs( ) or Rafter(~ I No, Stories Ioec~nt~dorNumberofEmployees No. Bedrooms: <br /> <br />Location oflnstallafion s/Tee r/'~, ~ ~re. qTJB i <br /> <br />~msatll~ ~r~ qqq~ <br />Mo~e I-Iom~ Pa~ S~ce ~ <br /> <br />Se~[on ~3~ Town~h¥ ~ Range ~&) 7~e ~Om Map Water Supply; <br />Lo, Width ~ff Lo, Depth [~O Acres i~eg, l.~t ~ ............. Comer ~5 Priva~eWell ( )Spring( ) <br /> ............ Commmxh) welJ ( ) ciW <br /> <br />3. ContractOr lnJbrmation <br />Pr°peny Owner [J, lOO(JgOCl) ~[111,1_~ [Mafl~gAddress ~ ~X ~Op~eNo: <br /> ( ) I own, reside in, or wilt rcs~e in the completed stratum. <br /> <br /> ( ) I undemmnd ~at i must mglster as a constmcfim eommemr J.t' the stmmure is sold or offered for sale before or u~n cmnpletion. <br /> ~wiII be my own gmemI contmcton <br /> <br />I1' i hire sub¢onmtctors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my r0Jnd and do blre a general contractor, 1 wilt oontract <br />with a contractor who i~ registered withe Con~tructlon Contractor's Board. and wJJl immediately ~gfiiy Madot~ County of the ~am¢ of the COnl.~'aetor, <br />Contrac or Busi e~s name & g 1Ma~g Address; ~Phone: <br /> ( ) i am a registered buktddr OR the authorized represcntatiw of a registered buildcn <br /> <br />4. Fee Schedule <br /> <br />A, VALUATION (See "Valuation Schedule" <br /> <br /> square footage.) <br /> <br /> (1) Permit <br /> <br /> (2) 5% State Surcharge (,05 x Al) <br /> <br /> (3) StmdtuI:al Plan Review 665% x Al) <br /> <br /> (4) Fire & [.ilh Safhly Plall Review (.40% x Al) <br /> <br />B. Miscellaneous Fees <br />(l) Driveway w/curb@ $7,50 = __ <br />(2) Driveway w/o curb @ $ I7,00 = ____ <br />(g) Site Plan Re¥lew (commercial only) (~. $79,00 = ____ <br />(4) Additional Phn Reviews or Addcndmns = __ <br />(5) Inyestigation Fee = __ ...... <br />(6) Rein~pedtion Fee @ $25.00 = __ <br /> <br /> (7) Other ltl~p~otions not li~Lcd above = <br />Rncn~rr: j~/0 Tm,I, $ ~Z4;. 8 ? <br /> <br />reverse side of this form, <br />Signature of Applicant: (19,~ 5" ~ ' ~ <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />