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2A. CONTRACIOR INFORMATION -- PLEASE INDICATE WHO IS <br />DOING THE WORK <br /> <br />Property Owner: (please print) <br />Mading .~ddres& <br /> <br />City: State: Zip: <br />Phon~: Fax: <br /> <br />I am the PROPERTY 0 WNER and own. reside i~. or will reside in the <br />completed structure and will be my own general contractor. I understand <br />tl~t I must regtster as a const~uc~3n contractor cf the structure L~ sold or <br />offered for sale before or upon completion, ltl hire subcontractors, lwilt <br />hire onl) sttbconlroctors registered with the Construction Contractors Bourn. <br />ltl change m) mind and do h~re a general contractor who ~s regtstered with <br />the Conslruc#on Contractors Board I wd[ immediately notia~ Marion County <br />of the name of Cbc contractor: <br /> <br /> Owner's Signature: <br /> <br /> Agent's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br />4. FEE SCHEDULE {complete and enter total in Al) <br /> <br />Furnace (includes dncte / vents) <br /> Air up to 100,000 BTU <br /> <br />$12.00 <br />$15.00 <br />$12.00 <br />$15.00 <br /> <br />Gas Furnace (up to 100,000 BTU') <br />Gas Furcta~ (ov~ 100,000 BTU) <br />Gas Fireplace / lns~ <br /> <br />Gas Log Lighte~ <br />Gas BarOque <br /> <br /> $12.00 = ~ <br />g $15.00 = $ <br />x $1530 = $ <br />x $15.00 ~ $ <br />x $15.00 = $ <br />x $15.00 = $__ <br /> <br /> $ <br /> <br />Suspe~d Heater <br />Wall }ieat~r <br />Floor Mounted Heate~ <br /> <br />x $12.00 = $ <br />x $12.00 = $ <br />x $12.00 = $ <br /> <br />x gl2.00 <br />x $22.00 <br /> <br />Air Conditioner <br />Unde~ 3 Ton <br />3 Ton and More <br />Evaporative Cooler <br /> <br />$1590 <br />$22.00 <br />$ 9.00 <br /> <br />Exhaust / Fans / Vents <br />Coral Exhaua Sysgm <br />Cornl Hood & Exhaust <br />Domestic P. aage Hood (includes ducts) <br />Dom~/¢ Exhaust Fans <br /> <br />Applmnce Veals in~a0nd and <br />not included in an appliance pernut <br /> <br />x $ 9.00 =$ <br /> 9.00 = $ <br /> 9.00 = $ <br /> <br />x $ 6.00= $ <br /> 6.00 = $ <br /> <br />BASE FEE A~se~sed on AL~ APPLICATIONS: <br />Al. EnterTotal Fees from Section g4 <br />A2 Add State Surcharge (.05% x Al) <br /> <br /> $ 25.00 <br />B. Enter 30% of line Al for Plan Review SUBTOTAL: ~ <br />D. Remspectton Fee ($50.00) $ <br /> <br /> (rain/mum one I;ou0 $ ~ <br /> TOTAL AMOUNT DUE <br /> <br /> <br />