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R.ec¢ived By: ~ [ <br />I Zo~ va~i%o~u ,,~4- I <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Su~et NE <br /> ,Xt/i <br /> <br /> BUmD~G PERM~ aPPL~A~ ~ 9 <br /> <br />COMPLETE ALL SECTIONS, 1 TI-~OUGH 4 <br />1. Job Description [~A[~ION CO ~TY <br /> <br />FOR OFFICE USE ONLY <br /> <br />Rear: <br /> <br />Pal#hr <br /> <br />2. Location of Installation t~f~' q <br /> <br />3. Coatractor Information . <br />Prc~rty Owner <br /> <br /> ) I own, reside hi, or w~l ~sid~ ~ ~e ~eted s~m~um. <br /> <br /> ) I ~dammnd ~at I must n <br /> <br /> ) I ~ be my o~ gme~ continuer, <br /> <br />Phone No: <br /> <br /> him subcontractors. I will hire only <br /> <br />Contracts~'Business name & #: <br /> g)Q am a regisu:r~d builder OR thc authorized r~ <br /> <br />4. Fee Schedule <br /> <br />ia the Consmstaion ~ <br /> and williimmediatel <br /> <br />Marling Address: <br /> <br />Board. If I change my mind and do hire a general contractor, I will contract <br />~ Marion County of the name of the c~mtraetor. <br /> <br />A. VALUATION (See Valuation Schedul~ : <br /> <br /> ~) 5~ Sta~ Sumha~ (.05 x A I) ' <br /> <br /> (4) Fi~ & ~e S~et' [) <br /> (5) 7~n <br /> <br /> (7) Other ][nsl~tions not listed abov~ x', = <br /> <br /> R~CEIPT: TOTAl. $ <br />I hereby certify that the above In/o~m ation "~s'correct and tha~ ! have t~ad and understand the Information Notice ~o Property Owners about Cons;ro¢tion Responsibilities on the <br />reverse side* of thi~ form. ,. . <br /> <br /> '%--~"~- ' ~- x,~*T,,"'~..' '"",---,i ,'~ ~ ' -, , ' -- ' <br /> , ~ ~ - / ~ /.-,. / <br /> <br /> / <br /> Site evaluations, septic, electrical, plumbing and mechanical work mqulrc se~ram p~rmits. Check with Marion County Building Inspection before aul~nitting this application. <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />