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FOR OFFIC~E USE ONLY[ MARION COUNTY BUILDING INSP~IN /FOR O'~FICE USE ONLY <br />Zo~ng Vali~fion:J [[[~ [ 28sm~St.~ - loom 132 <br /> <br /> CO~E~ ~L SECTIONS, <br /> <br /> 1. Job D~rlpfion <br /> <br />2. Location oflnstallatfon /O~o~barta, Git& 9'?g 7! <br /> <br />3. Contractor Information <br /> <br /> ( ) I om, reside ~, or ~ msld~ ~ the cmpletod stm~. <br /> <br /> ( ) [ undated ~at I must ~s~f as a ~st~ e~ ff ~e s~m ~ sold of offa~d for sale ~om or u~n ¢mpl~fi~. <br /> <br />A, VALUATION (See "Valuation Sdaedul¢" <br /> <br /> to d~telmine valua~on based an <br /> <br /> (2) 6~ st~ s.r~h.~ 605 ~ Al) = ~, ~ ~ <br /> (3) Structural Flan Review (.~% x Al) = ~t ~3 <br /> (4) Fire & ~fu SatZly ~an Review (,~% x AI) ~ <br /> <br /> (5) ~>ning Surcha~e, if app~cablc 605% x Al) = ~ <br /> <br />B, Miscellaneous Fees <br /> <br /> (1) Driveway w/¢urb@ $7,50 <br /> <br /> (2) Drlveway w/o curb@ $17,00 <br /> <br /> ('3) Si~ Plm Review (~,nmetci~l c~ly) @ $79,00 <br /> <br /> (4) Additional Plan Reviews or Addeadtlrns <br /> <br /> (6) II~impectie~ Fee@ $25.00 <br /> <br /> (7) Other IIISl~etions not l~S~ed above <br />REcEr~ / 77 7 <br /> <br />= <br /> <br />= <br /> <br />= <br /> <br />I hereby e0rtify that the above information is correct and that I have mad and undcr~tand the Information Notice to Properly Owners about Constnlcllon Rcspcmsibil/tics on the <br />reverse side of this form, <br /> <br /> Site evaluations, ~cal, plumbing and m¢cbanical work require scperate permits, Check with Marion Coumy Building l~spe~ion before ~ubmitti~g this applicafiom <br /> MC I5-73 Rev 8/94 <br /> <br /> <br />