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FOR omc; USE O) LYI <br /> <br />~Zontng Validation; ~.zk&td,~' I <br />I Date: , ~-c>7 ,~'-~-~- ........1 <br /> <br />MARION COUNTY BUILDING INSPECTION F~_ OFFIC~E US~E ONLY <br /> <br /> BUILDING PERMIT APPLICATION <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br /> 1. Job Description <br /> <br />RESkDENTEAL I COMMERCIAL <br /> ( ) Addition ( )Relocalio~ ( )Addlilon <br /> (~Almtailon ( )Demrditi~ ( )~tera~ion <br /> ( ) AccessoW ( ~ther ( ) Change of Occupancy <br /> <br />Square Fret: Basment: I Ma~ ~r: L S~nd <br /> <br />Sign <br />Demolition <br />Other <br /> <br />Height: / <br /> <br />2. Location of lnstallatlon <br /> <br />Pr°Per~yOwnerJ~/~.t~*7"~ S '~et~/~}~- I MaillngAddress .~, ~t~"~ ~/~ I- <br />Cross Street <br /> <br />Mo~le Home Park Space ~ <br />LotWidth ~ LotDepth /~ ' Acres I~eg,~tffO Comc:r V~'S ...... PrlvateWell ( )Spring ~. <br /> <br />3. Contractor Information <br /> <br />If I hire subcontractors, I will hire only subcontractor~ registered with the Construction Contractors Board. If I change my mind and do hire a general contractor, 1 will contract <br />with a contractor who is regislemd wilh~ Constmcrion Contractor's B ~]~rd. and will immudialely nolffy Marion Co;;nly of tile name of the <br /> <br /> ()[ama registered buRder OR ~e au~odz~8 repmsentat[ve ora registered bffilder, ~ <br /> <br />4. Fee Schedule <br /> <br />A, VALUATION (See "Vahmtion Schedole" <br /> <br /> square <br /> <br /> (1) Permit Fee <br /> <br /> (2) 5% State Surcharge (.05 x Al) <br /> <br /> (3) Sla~clura] Plan Review (,65%xA1) <br /> <br />Valuation: <br /> <br />B, Miscellaneous Fees <br /> <br /> (1) Driveway w/curb@ $7,50 <br /> <br /> (2) Driveway w/o curb <br /> <br /> (3) Sile Pkm Re¥iew (c~nmercial only) ~ $~9,(X) <br /> <br /> (4) Additional Plan Rev(ew~ or Addendmns <br /> <br /> (5) lilvesligalion Fee <br /> <br />(4) Fire & Life Safety Plan Review (.40% x Al) ............. (6) Reinapeetion Fee Q~ $25.00 = ........... <br />(5)d~<',';.~.~::::h::~;:t,:r..l,Vl;~.a:2~.(.:lff~x.a.!) = ~ (7) O~her Insi~cfi~s no~ lis~ed ;d~ove = ...... ~ <br /> <br />MC 15-7.3 Rev. 11/91 <br /> <br /> <br />