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I OR ONL I <br /> Received By: ~:/2/~ <br /> Zoning Validation: ~ [ <br /> <br />MARION COUNTY BUILDING INSPECTION IFOR O'~FICE uSE .ONLY <br /> 22.0 High Stxeet ~ I City s~t~¢k V. eq~i,~,~: <br /> <br /> 8;~ - 4:3~ ~one 5~7 ff ~ghi side: ~ <br /> <br /> FAX 588-~48 <br /> BVmOmG PER~ APPLIC~[O~ ~ i993 <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 Y~RION COUNTy <br />1. Job DeSCrl )rich UI£DIN t5!S?£C? <br /> <br />2. Location of Installation "'~ <br /> <br />3. Contractor [nformafion <br />PtOl;mnyOwner~p~'/Y~.~"?e/~, ~_~ [ M~gAdd~ <br /> ( ~ o~, ms~c ~, or ~ ~alde ~ the ~mpleted:stm~u~. <br /> ( ) I unden~d ~a~ I must m~s~r as a ~stm~ ~c~ ff ~e s~um is sold or ~e~ fo~ sa~ b~ or u~ c~plefi~. <br /> <br /> ( ) I will ha my own g~ <br /> <br />If I Mre subcontractors, I will him only subcontractors registered with the Construction Contractors Bovril. [f I change my mind and do hire a general contractor, I will contract <br />with a contractor who is ~egistemd withe Construction Contractor's Board, and will immedialdy notify Mafion,Cou~nty of the n a~m. e ?f~ ~e ~oa.~Scto r <br /> <br />Awhi~etname: MaillhgAddmss: ,. ·. Phone: <br /> <br />4. Fee Schedule <br /> <br />A. VALUA'flON' (See "ValUation Schedule" ' B. Miscellaneous Fee~ ' :' <br /> · " ~ ' ' il) 'Driveway w/curb @ $7,50 <br /> m determine valuati6n based ~a: ' fi ~-~ <br /> square footage.) Valua on- 7~c'~ (2) Driveway w/o curb @ $17,00 <br /> ~aff~.-~_ . ('3) 8i~ Plan RevUew (commemlal coly) @ $79.00 <br /> (~) 5% Sm~e Surch~ige (.05 x A I) /Z~" (4) Additional Plan Reviews Or <br /> (3) $tm¢]~ural PAn Review (,~% x Al) ,(5) Inv~sti§afitm <br /> (4) F~r~ & Life Safety Plan P,~vi~w (.40% xA ! ) (6) ReJ, nspecfion Fee @ $~.00 · <br /> (5) ~fing Su~ha~e, if app~eable (.05~ x Al) ~) O~er hs~c~S not ~st~d above <br /> <br />reverse ~{de of this form <br /> <br /> Site evaluafi~a, sep~c, e~rical, plumbing md mechaniml wo~ require se~mm pc ' a. Check wi~ Mafi~ Coomy Build~g Inspe~ion ~fom gubmlttMg ~is a~cafion, <br /> <br />MC 15-73 Rev. llD1 <br /> <br /> <br />