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MARION COUNTY BUILDING INSPECTION <br /> 5501e~,g~)SR 97tree~(~j~ ~ __ <br /> <br /> BUILDING PERMIT APPLI~IO~I ~995 <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br /> MARION COUNTy <br />L Job Description B~IILD]NG I[~'~F~.u, I <br /> <br />2. Location of installation <br /> <br />Contractor Information <br /> <br /> ) I un~nd ~at I must ~s~r as a c~sgmcfi~ c~tmc~ ff ~e s~um is sol~ or ~d for sMe b~o~ or u~n <br /> <br />If I blm subcontractors, I will hire only subcontractors registcre, d with the Constrnaion Contractor* Board. If I changa my mind and do hire. a general contractor, I will contract <br /> <br />4. Fee Schedule <br /> <br />A. VALUATION (See- "Valuation Schedule*' <br /> <br /> square footage,) <br /> <br /> (I) Permit F~ <br /> <br /> (2) 5% State Surcharge (,05 x AI) <br /> <br /> (3) Stnlctuval Phn Review (,65% x Al) <br /> <br /> (4) Fire & Lile Safety Plan Review (.40% x Al) <br /> (5) Zoning Surcharge. if applleahie (,05% x A I ) <br /> <br />Wm~n: s q77¢ <br /> <br />B. Mi~eelI~neous Fees (I) Driveway w&ufb @ $7.50 <br /> <br /> (2) Driveway w/o curb @ $17,00 <br /> <br /> (3) Sit~ Phu R,¢~iew (~emmemi~t o~ly) @ $79.00 <br /> <br /> (4) Additional Plan Reviews or <br /> <br /> (5) Investigation <br /> <br /> (6) Reinspecton Fee@ $25.00 <br /> <br /> (7) Other Inspections not listed above <br /> <br />1 hereby cenlfy that the above information is correct and that I have mad ~nd un~lemtand the Infonnation Notice to Property Ownera about Construction Responsibilltie,q on thc <br />rever*¢ side ofthls form. <br /> <br /> Sit~ evaluations, septic, electrical, plumbing and mcehaaieal work mqul~ seperatc permlts, Check with Marion County BulldJ/~g Inspection befog3 ~ubmittmg this application. <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />