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MARION COUNTY BUILDING INSPECTION I~F,O~n,OFFICE USE ONLY <br /> <br /> C~e-A-Pho~588-790~ ~ m~ 1 / 1~1~ ~ / ~ <br /> FAX 588-7948 ~ ~u ' - ~ <br /> <br /> BUILDING PERMIT APPLICA~M ~0[~I4I~ <br /> lt0N <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 ~l~fi ~[~ <br />1. Job Description <br /> <br /> RE SLD ~13aNvl'IA L COMMERCIAL ( )New Use of Structure; <br /> <br /> ( ) Alteration ( )D~]no~li~ ( )Al~ration (~emo~d~ <br /> { ) Accesao~ ( ) O~er ( ) C~ange of Oeeu~ncy ( )O~er <br /> <br />T~ss< ) o, ~=f~< > I No, mod~ ~ IOccu~nt~dorNumberofnmployees .................. ~,,~[[o,T[~2: <br /> <br />Location of Installation <br /> <br />Mo~e lime Pa~ Space ~ <br />Sec6on / Town~Np /D~ Range ~ Z~e ~ Map/~/O~~ Wa,erSu~ty: <br /> PrNamWell ( ) Spring <br />LotWidm }~,,,,,, ........ LotDeplh 1~ / Acres I=c'g.~t C°mer iA~ Commnnit>Wall( ) Ci,y <br /> <br />3. Contractor Information <br /> <br /> (~ own, reside in, or wild reside h~ ~e ~mpleted stmau~. <br /> <br /> ( ~ wi~ be my own gmcral contactor. <br /> <br />If I hire subcontractors, I will him only subcontractors registered with the Construction Contractor~ Board, If I change my mhld and do hire a general cotltractot I will corn ra¢l <br /> <br />Contractor Business name & #: [ Ma/ling Address: [ Phone: <br /> ( ) I am a tegislemd bttilder OR the authorized mprexentative of a registered builder, <br /> <br />Architect name: T Mailing Address: ] Phone; <br /> <br />4. Fee Schedule <br /> <br />A. VAI,UATK)N (See "Valoafion Schedule" <br /> to determine valuation based <br /> square f~tagc,) <br /> (3) Pe~nit F~ <br /> <br /> (2) 5% State Surcha~e <br /> <br /> O) $tmcmral Plan Review 665% x Al) <br /> (4) Fire & Life Sdety Plan Review (.40% x A 1) <br /> (5) 7xming Surcha~e, if applicable (,05% x A I) <br /> <br />Valuation: $.__ <br /> <br /> .75- <br /> <br />B. Miscellaneous Fees <br />(1) Driveway w/curb ¢0} $7,50 <br />(2) Driveway w/o curb @ $ t7.00 <br />(3) Site Plan Review (coxnmer¢ial ordy)@3 $79.00 ~ ..... <br />(4) Additional Plat) Reviews or Addcndmns <br /> <br /> (5) btvestigafim Fee <br /> (6) Relns~cti. Fee Q> $25.00 %.~ '.: ~ <br /> ~) Othat ~IS~CI~(>~S 1101 ]iSled above j~'~' 7-'~ <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />