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FOR ..... OFFIC~E USE QNLY[ MARION COUNTY BUILDING iNSPECTION ~FOR OFFICE USE ONLY <br />[ZoningValidation:~ v ~//g ] .\\kj 8:00am.4:30pmPho,e588-5147 [Fro~t: ~,~eg' I Rear: ,.~r <br /> <br /> COMPLETE ALL SECTIONS, 1 THROUGH 4 ~t~ <br /> <br />Locationonnaanation P'e/ze..r P T. qv,5 <br /> <br />~t Wid~ g~ p L~m~ q ~y/ ~* ~eg. ~t ~ ~mer Y~$, Pr~vateWellcomm~,~ Well (()),, Spri~gcity ~" <br /> <br />Contractor Information , ~.~,/~'d/~'-r',4/,'~/~/gl <br /> <br /> ) I own, re~id~ Jrt. or will I'~ide Jn th~ eomplet*d ~tmcture, <br /> <br /> ) I under,~ancl that I mast register a~ a eor~qtruction contractor if the ~tructure is ~ld ~r otter~I for sale before or upon completion. <br /> ) I will b~ my own gecoral contractor. <br /> <br />If I hire subcontractors, I will hire only suh~ontr~o~ registered with the Construction Contractors Board. If I change my mind and do hire a general contractor <br />wile is regi~tertXl with the Collstroction Contractor's Board, I willimmedialely notify Marion County of the name of the eontra¢or: <br /> <br /> (~ ~ am a registere, d builder OR, the authorized representative of a registered builder. <br /> <br />4. tee <br />A, New One.anti-Two Family Dwellil~g C~e <br />0nl~d~ El, Mo, B) Valuation: $ (I) ~v,wgy w/~b ~ $7,50 <br /> <br />(I) Gross sq. Ft./.-q~ff-, ,x $.2s <br />(2) 50/0 State Surcharge 605 x Al) <br /> <br />(3) Plan Review <br /> <br />(4) Zoning Surcl'u'Wge ($15 if applicable) <br /> <br />$185,00 <br /> <br />(2) Driveway wit ~u~ @ $17,00 <br /> <br />(3) Additional Plan ReViews or Addendums <br /> <br />(4) Investigation Fee <br /> <br />(5) ReinsFection F~ ~ $25,~ <br />(6) ~er Ins~ons not I~s~d ~ve <br /> /771 <br /> <br />__x$40 = _ ..... <br />TOTAL $.,. ~j /~,.~.q-~ <br /> <br /> l h~teby certify that the above ioforination is Correct and that I ]lave read and lander~and th~ [nfixmatlon Notice to Prettily Owners abo~Jt Conslrucfioll Responsibl es on the <br /> reverse side of thi~ £otm. <br /> <br /> Sbt evaluations, septic, eloafical, plu~nbing and mechanical work req~r* se~ate ~, Check wi~ M~ion County B~lding Insl~ion ~fore subnglfag ~is ~plicadon. <br />MC 15.80 Rev, 1~2 <br /> <br /> <br />