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FOR C1T~. V3k.LIDA~ION <br />IReceiv. ed~By:' /~ ~ ~ <br />~ng V~dation: <br /> <br />CO~'r~ ~ S~ONS, 1 ~OUGH 4 <br />1. JOB DESC~ION <br /> <br />MARION COUNTY BUILDING INSPECTION FOR CITY USE ONLY <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St. NE~'Room 132 City Setback Requimmeats: <br /> <br /> 24 hr. Inspecfld~i'Lii~_S~.?904 7 ~, - . . · <br /> BUILDING PERMIT ~ICA~IO~ /~ <br /> <br />2. LOCATION OF INSTALLATION /Q ~, .~e~t .,~ ~ gg <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />/ <br /> <br />4. FEE SCHEDULE <br /> <br />on square footage of project.) <br /> <br />(1) Pcmfit Fee <br /> <br />(2) 5% State S'mcharge 605 x Al) <br /> <br />O) Stmemrni Plan P~view 665% x Al) <br />(4) Fire & Life Safety ~ Review (.40% x Al) <br />(5) Zoning Surcharge, if applicable (.05% x A 1 ) <br />(6) Seisn~ Surcharg~ <br /> <br />B, Miscellaneous Fee~ <br /> <br /> (1) Additional Plan Reviews o~ Addendums <br /> (2) Investigation Fee <br /> (3) Reinspection Fe~ @ $25.00 <br /> (4) Other lnsgccfions not listed above <br />~cmr: qq~oo <br /> <br />TOTAL <br /> <br />=$ <br /> <br />I hereby certify that the above information is correct. <br />Permits am non-transferrable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. <br /> <br />Name of Applicant (Please Prhlt): ~'~ &~.~ ~ ~t~t/~ Phone: <br />Signaturo o f Appllcant: ~ Date: <br /> <br />MC 15-73 Rev ID5 <br /> <br /> <br />