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MARION COUNTY BUILDING INSPECTION <br /> <br /> FOR CITY <br /> <br />IZotliRg Val'~dation: <br />[Date: /A~- / <br /> <br />COMPLETE ALL SECTIONS, I THROUGH 4 <br />L JOB DESCRIPTION <br /> <br /> ..,,FOR CITY USE ONLY <br />ltS:emack R~quircmcnt! :Rear: /~9~, <br /> Side'. I Right Side: <br /> <br />RES IDF. NTIAL <br /> ( ) Add[tiua <br /> <br /> ( ) Almration <br /> <br />( ) Alteration <br /> <br />( ) Chm~ge of Occupancy <br /> <br />( ) Other <br /> <br /> COMMI~211TY DEVBLOPMENT CENTER <br /> 28~u~t. NE - Roolu 132 <br /> <br />BUIL~~ <br />coMMERCIAL <br /> <br /> ( ) Sl,n /~ ¢ 2-V ' <br /> ( ) Othe~ <br /> <br />S~fiOn ~0 T~nship ~ Range I ~.e ~ Map Water&xpply: <br /> ~vate Well ( ) <br />Lot Wid~ ,,,~ ~ Depth/~ ~ ~rm l~g. ~t ~ ~ C~0~r ~ Co~mualty WeLl ( ) City <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WltO IS DOING THE WORK <br /> <br /> MllilingAdd '~ / ~- t~ ,- ' ~, . . <br /> <br />4. FEE SCEIEDULE <br /> <br />A. <br /> <br />(3) Reinapeetlon Fee ~ $25,00 <br /> <br />I hereby certify that file abovo information is ~orrect, <br />Permits are non -transferrable and exp~r~ if work ~s not started w~ithln 11~0 days of {ssuall{e or if work is SUSl~nded for 180 days. <br /> <br /> <br />