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IFOR OFFICE USE.ONLY <br /> ]Received By: 60(/, ~ <br />· : /Z0ning ValidationS: '~'~' <br /> IDate: )p_. <br /> <br />MARION COUNTY BUILDING/NSPECTION <br /> 220 Itigh Street NE _ <br /> <br /> BU~D~G PERM~ APPEllAtiON <br /> <br />1. Job Description r~ll{[,gl~ ~'' ..... <br /> <br />RESII3BNTIAL ~OMMERCI~L ( )New " Us¢ofStmettl~: <br />( ) Additio~ ()Relocation <br />( ) Ahemtion ( )I)emolltlm ( )All,ration ( )D~molltion <br />/)Accessory ( )Other ( )Chang~ofOccupancy ( )Other <br />"i'm~s ( ) of l~ter ( ) ] No, Stories <br /> <br />2. Location of Installation <br /> <br />3. Contractor Information <br /> <br /> (~ I own. reside ~. or wal mslde ~ ~e cmpletcd stratum. <br /> ( ) I md~nmnd ~a~ I must mglsmr as a c~stmc~ conmc~ ff ~e s~um is sold or offered for sa~ befo~ <br /> <br /> ( ) I will ~ my own g~ ~ntm~on <br /> <br />~f ] hire subcorl[nletor~, I will him only $~beontra¢£ors mgi~t~ wi~ ~e ~ns~i~ C~cmm B~, ~ 1 ~ang~ my ~r~ and do hire a genera~ conttact~, ~ will ~ntmct <br /> <br />4. Fee Schedule <br /> <br />A. VALUATION (Se~ 'Valuat/on Schedule" <br /> <br />B, Mi*cellmeoa~ F~s ~ <br /> <br />&¥ 15' <br /> <br />~qmlte footage,) <br /> <br />(1) Permit <br /> <br />(2) 5% Sta~ Sumhaqle (,05 x Al) <br /> <br />(3) Structural Plan Review (,65% x Al) <br /> <br />(4) Fire & Life Safety P/an Review (.40% x Al) <br /> <br />Valuation: $ - ~ <br /> = z <br /> <br />(1) Driveway w/curb @ $7.50 <br />('2) Driveway w/o curb @ $17.00 <br /> <br />(~) Sil¢ Platl Review (cornmemial coly) @ $79,® <br /> <br />(4) Additional Plan Revlew~ o~ Addcmdums <br /> <br />(5) hves~gafi~ Fee <br /> <br />(6) R~S~C~ Fee ~ $25,00 <br /> <br />(7) ~er hs~c~s not ~stcd above <br /> <br />Name of Applicant (Please Ptin~:l [. ~,¥s~ I'~ l/l,x~ ~ (' t~ ~ <br /> <br /> Site eva]uath>vl5, septic, ele=lri~l, plm ~b~g and mechanical work requlre separate permit~. <br />MC 15-73 Rev. 11/91 <br /> <br />hereby cerlify that the above information is correct and that I have read and understand the IMormatioa Notice to Properly Owner* about Construction Responsibilities on the <br /> <br />Check wt h Marion County l/ulldmg Inspection before qubml%ting this app mauon, <br /> <br /> <br />