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Received <br />Zoning Validation:l/-/~/~ <br /> <br />COMPLETE ALL SECTIONS, ! THROUGH 4 <br /> <br />MARION COUNTy BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> <br />FOR CITY USE ONLY <br /> <br /> 285 Church St. NE - Roo~i~2t....- City Setback <br /> s,lo , / <br /> 8:00~-&30p. Phone ~/~ F~ Front: /~/ ~: <br /> <br />BUILDING PE~IT APPLI~ { ~//"j/~f~ <br /> <br />1. JOB DESCRIPTION <br /> <br />RESIDEN'i'I~L "~OMMERCIAL ""2 <br /> <br /> ( )Addition ( )Relocation ( )Additioll i ( )New <br /> ( ) Alteration ( ) Other ( ) Alteration ( ) Sign <br /> (]/~/Accessory ( )Ch~geofO~eupancy ( )Other <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATEiWHO IS DOING THE WORK <br /> <br /> ( ~ I am an ~ UT~OR~ED ~gNT A ~ of ~c pro~eay Own~r or cone~r. <br /> <br />4. FEE SCHEDULE <br />A. <br /> <br />VALUATION (See "Valuation Schedule" to det~mlin~ valuation bo*ed <br /> <br />on square footage of pmj~,) Valuation: $ ~ <br />(I) Permit <br /> <br />(2) 5% State Surcharge (.05 x Al) <br />(3) $t~urul P,an Review (,6S% ~ Al) ~, <br /> <br />(5) ~alng Surcharge, if applicchl~ (.05% x Al) <br /> <br />=$ <br /> <br />I hereby eerlJfy that the above information is correct. <br />Permits are non-transt~rrable and expire il' work is not started wilNn 180 days of issuance or if work is suspended for 180 days, <br /> <br />NarneofAppl}¢ant(Ple ~ rho.e: / _ ....... <br />MC 15-73 Re¥ 1/95 <br /> <br /> <br />