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I FOR OFFIC)~ USE QNLY MARION COUNTY BUILDING INSPECT Nm FOR OFFICE USE ONLY <br />{Rec¢tve~ By. /'~,ic, 4' RU~-~ ~0~ ......... /~ ~ .... : ..... <br />I <br />i. Job Descr~ptmn <br /> <br />2. Locatiou of Iustaltatlou ~.~d ~t.~. ff 7o ~,~ <br /> <br />3. Contractor Information <br /> <br />own. t~side in, or will n~sida in the completed strac~um. <br /> <br />understand Ihat I must r~gis~r as a aonstractlon contcacmr ii' the sUUgur~ is sold or offered for sale before or upon completion, <br />wil/be my own g~noral contractor, <br /> <br /> / <br />4. Fee Schedule <br />A. VA~UATIO~ ($c~]'TVaiuafion <br /> ~o ddmrrain~ valu~t/oa based en <br /> squara fcc;age.) <br /> (1) Permlt F~ <br /> (2) 5% Statc Surcharge (.05 x Al) <br /> <br /> 0) Structural Plan Review (.65% x Al) <br /> (4) Fire & Life Safe;y Plan Rcviow (,40% x Al) <br /> <br /> ' ' " ' ' ' '"5% <br /> <br />(1) Driveway w/o~eo @ $7.50 = __ <br />(2) Ddwway w/o curb @ $I7,00 : ~__ <br />O) ~it~ Plan Renew (¢~me~al ~Iy) ~ $79.~ = ~ <br />(4) Addl~onaI Plan ReMews or Addmduma = .., <br /> <br />(6) R~s~cd< Fcc ~ $25,00 = ~ <br />C) Omar ~s~ca~s not lis~d abo~ = ~ <br /> <br /> hereby cealCy tha~ tho above ir, format{on is o~rmct and ~hat I have mad an6 undem~n~ ~e ~f~ti~ N~icc to pmpmy ~nem ab~t Cmstmcfion Resp~aibifities on ~e <br /> <br />Site cvaluati~s, s=pQc, cl=aric~L plumbing and mechanical wo~ <quire $~ntc p*~its. Cheek wire Marion County BMlding Inspc~ion ~fo~ ~u~ittMg ~ix app~eadon, <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />