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FOR OFFICE/jIJ~SE O~Nz;I~¥ ] <br />Receiveg By: ~~ <br /> <br />MARION COUNTY BUILDING INSPECTION ~ USE ONLY <br /> 220 High Street [~[~- ~ ~ ~ [1 ~ <br /> <br /> F~588-7948 0eT ~ 1 l~a <br /> <br /> BUILDING PERMIT APPLIC~4GOU Nj.¥ <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> BUILDING IN~PEC?ION <br /> 1. Job Description <br /> <br />2. Location of Installation <br /> <br />Su~ivisi~ ~t Bl~k <br />Section Townshp Range Zme ~. Map Water S0pply: <br /> Pfiva~Wc)I ( ) Spring ( ) <br /> <br />3. Contractor Information <br /> <br /> ~I own, <br /> <br /> ( ) I wffi be my <br /> <br />~[ I hi~ subcontractors I will him only subcontraetor~ registerext with the Cxmstm~ion Contraetor~ Board, If I change my mfnd and do hire a genera] contractor, I will contract <br />w~th a contractor who is registered withe Construction ContractOr's Board, and willinunedlately notify Marion County of the name of the contractor, <br /> <br />(x~) I am a registered builder OR ~e authoriz~ed reproschtatlve of a registered builder. I <br />Archi c,.a e, 5x- ' <br /> a-~ 'l-O~l .... <br />4, Fee Schedule <br /> <br />A. VALUATION (See "Valuation Schedule" <br /> <br /> (i) Permit Fee <br /> <br /> (2) 5% State Surcharge (,0S x Al) <br /> <br /> (3) Structural Plan Review (.65% x Al) <br /> <br /> (5).gZ~,ff-applMabl~.05 %- x-A'l ) <br /> <br />B, Miscellaneous Fees <br /> <br /> (1) Driveway W/curb @ 87.50 <br /> <br /> (2) Driveway w/o curb @ $17.00 <br /> <br /> (3) Site Plan Review (¢ommen;ial only) @ $79.00 <br /> (4) Addi~onal Plan Revlews or Addendarns <br /> (5) Invesilgafion Fee <br /> <br /> (6) Rednspeoion Fe~@ $25.00 <br /> <br /> (7) Other In~¢tionz not listed above <br />RECEIPT; /dg~/"7 <br /> <br /> e~ i C~°3,,O ...... Phone: co31 - IIq7 <br />c,e ork .quire seperate pernuts Check with Mari:n :ounty B mldln: :'nspeet <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />