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RI~$IDF~NTIAI. COMMERCIAL ( )New Use of Structure: <br />( ) Alteration ( )Demolition ( )Alterat/on ( )Demolition <br />(A~cCCSSory ( )Other ............ ( )ChangeofOccupaney ( )Other <br /> <br />T=,< > °' ) I No-Stodds [OecupantLoadorNumlm-ofEmploy~ No, Bedrooms; <br />Squa~ Fe~t30{~ Ba';';r~;nt: l Main Fleor: t Second Floor: I Other: H~ighu ] O l ' <br /> <br />Location of Installation <br /> <br />PropcnyOwner _~Oo.~l.~t~t. ~t~Dr,~q ] MailingAddr~$s ~1373 ~A~ ~Ct~k PhmeNo. Vr~..~q~ <br /> <br />........ ,~a,~,si/,[lr~' ~q,. ~73~5 silgo. <br />Subdivision ~[ Bilk <br /> <br />S~tloa Tomskip Range 7~c Map Wa~r Su~ly: <br /> PfivamWelI ( ) Spring <br />L~"~id~ ~q LotD¢~h lOC AC~S I~¢g.~t Comer CommunityWe~ ! Cll7 <br /> <br />3. Contractor Information <br /> <br /> ~.)I own. reside in. or will in completed structure, <br /> the <br /> <br /> ( ) I underaland that I must register as a constructloll contractor ff the stluetur¢ i$ sold or offered for sale befol~ or ulx>n eompl*tion. <br /> <br /> ( ) I will be my own g~mcral contractor <br /> <br />If I laze saboanrxactom, I will him only subcontractora mgiste~M with the Construction Contractor* Board. If I change my mind and do kite a general contractor, l will contract <br />with a contractor who is mglster~d withe Construction Comractofs Beard, and will immediately noilly Marion County of the name of the contractor. <br />Contracmr Business name & g: CCLp,-~Oi ~cu~,x~4 q9--~$ JMailing^ddress: ~tg <br />~}~am }~gistered bulldm- OR u~e authorized repr¢hntet~ve of a mgistere, d builder. I <br /> <br />Arahi[e¢,name: ~'~ I.]O-~O,~ ]MailingAgdmss: D~_f~,~O~,4 '"{'Phonm 363-17Il <br /> <br />4. Fee Schedule <br /> <br />A. VALUATION (gee "Valuation SehedulA" <br /> to determine valuation based on <br /> ~qua~ footage.) <br /> (1) Permit Fee <br /> <br /> (2) 5% State Surcharge $05 x A 1) <br /> <br /> C3) Structural Plan Review (.6,5% x Al) <br /> (4) Fire & Life Safety Plan Review (,40% x Al) <br /> (5) Zo~ting Surebarge if applicable (,05% x A 1 ) <br /> <br />Valuation: $ ~-~f~ ~ <br /> = L~-~ <br /> <br />(I) Driveway w/curb @ $7,50 <br /> <br />(2) Driveway w/o curb @ $17.00 <br /> <br />(3) $ile Phn Review (COmmercial only) @ $79.00 <br /> <br />(4) Addifiooal Plan Reviews or Addendums <br /> <br />(5) Inves6gafion Fee <br /> <br />(6) Reinspection Fee @ $25,00 <br /> <br />(7) Other Inspectioos not listed above <br /> <br />Ir ~vee~be~ ~de: iofyf t ~t ~ ~ tohnen ~ b o v e ioformalls~ is correct and ~at I have read and utldel~tend th~ Irdotma,ion Notice to P~e~y Owners about Cmitmction <br /> <br /> Site evaluations septic electrical plumb~d mechanical work require Re~rate ~itS Check wi~ Marion Coumy Btdld~g Ins~ctlon ~fore submitting ~is application. <br />MC 15-73 Rev. 11~1 <br /> <br /> <br />