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[ecF. OR-CITY VALIDATION[ MARIONcCoO~m~o~~B~U~o~DM~rr~Gc~S~PECTION I FOR CITY USE ONLY <br /> eivedBy: t//~_~ q ~ I 2SSChurchSLNE- Room132 ICitySetbaekR~luimnents: <br /> <br /> ni~gValidafion: '~gY~ .~1~:,: .... ~"~ :~8:(g)in~l'}3~mphone~sl47 IFrone c:}g} [lt~:..~--r <br /> <br /> w-,--. -- r --? ..... I - FAXS88-7948 - I ~'~ I -' '"~ <br /> <br /> : ~:':::: ,: ONE &:TWO F~Y DWELLING PERMIT,~PI~ICATi( <br /> ~ . . ~ *Inclgdes el~ mechan!c~t_~ ~lumbing fees : . :.'i' <br />COMPLETE ALL sECTIoNs, 1 THROUGH 4 ~ . :~ ' tg <br />1. JOB DE$C~O~ <br /> <br /> ling wii l)etaCh~d Oara~ <br /> '""! ( I ' ' ~: : <br /> <br />( ) New Duplex <br /> <br />BUILDING INSPECTION <br /> <br />( ) I am Ibc PROPERTY OI~qRR s~d own, r*sid~ in, or will msid~ in th* compl¢,~l slmctn~ ~ ~11 ~ my ~ gm~ ~r. I ~ ~ I m~~ ~~ <br />co~tractor if file slmCmre is sold o~ off. ed for ~ before or upon completion. If I hire subconlrac~rs; I will hire only subconlaaclors r~ with h~e Consh-a~tion Comracqa~ Board. <br />If I change my mind nnd do him a general contractor who is zegistered wi~ t~e Construction Contrnctots Board. I will ~ ~ ~ ~ of ~e ~ of ~,~. <br /> <br />( ) . laman~UTRORa~nRgPRESgNTATlV~of~heprop~'y~,~ .... . ~; .... ." i ~ . <br /> phline ' ,., ,, <br /> <br />4. FEE SCHEDULE <br /> <br />VALUATION - Bas~lon squar~ f~otase:x <br /> <br /> TOT~: <br /> <br /> $.345 PER SQ <br /> <br />I. Permit Fee (A-l) = $ <br />2. StateSu~harg~(i%ofA-l) =$ -':~ql:~ ~ I <br /> <br />5. l~fi~ F~ ($;~5 ~ ~R) '- = S >~ :- <br /> <br />7. ~ ~ ~.~M(I ~) =S <br /> <br /> TOT~ = i~~. <br /> <br />Dwemng labels must be obtained at Marion County Building Inspection and must be placed at the jobsite prior to inspection for plumbing, electrical and <br />mechanical woFk. Contact Marion County for instFuctions. <br />I hereby certify that the above informati0n!:is~ ~ ~.,~ n0!t-tra~,,ferrablc and expire if work is not started within 180 days of issuance or, if work is suspended for <br />1~0 days. ' <br /> <br />MC 15-80 Rev 1/96 ~.~ <br /> <br /> <br />