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MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CBNT~R <br /> 285 Church fl~'q~l~ - Room 132 <br /> <br /> 8 :OOmm- 4: - <br /> <br /> BUILDING PERMI'PF~pI/ICATIO~ / ] /,~ <br /> co Z 995 <br /> <br />COMPLETE ALL SECTIONS, I THROUGH 4 <br /> <br />,FOR OFFICE USE ONLY <br />City Setback Reqm,rements:: <br /> i<' 10' <br /> <br />2. Location of] nstallatinn fa ~e~ot.~Z~. q73L'23~ <br /> <br />3. Contractor information <br /> ( ) I om, reside in, or will reside ii1 the completed structure, <br /> <br /> { ) I will be my om gtmeral o3ntraclor, <br /> <br />Arctli~¢t name: A/. ~,~ ~ ~' l MaiJillg Adgl~.,$s: <br />4. Fee Schedule <br /> <br />A VALUATION (See "Valuatmn Schedule" <br />to determine valuation based on <br />muar~ footage,) Valuation;; <br />(1) Permit Fee <br />(2) 5% State Surcba~e (.05 x Al) <br /> <br /> (~) /xming Surcha~e, if appUcablc (05% x <br /> <br />B, Miseelhneous Fees <br /> (1) Dnveway w/curb @ $7.50 <br /> <br /> (2) Driveway win curb @ $17 <br /> <br /> (4) Additional Plan Renews or <br /> <br /> (5) ~vesfi~ Fee <br /> (6) Re~s~c~ Fee (~ $25 00 <br /> <br /> O) O~er~s~cfi~s not lismd above <br /> <br />hcrcb3 certify that the above information is correct and that I have Icad and understand the i~ffomlation Nouce [o PrOperty Owners about Construction ResponsJbgalles on thtJ <br /> <br /> <br />