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iOR .CITY V~LIDAT~-----'~ MARION COUNTY BUILDING INSPECTION <br />~eived B~: ~ <br /> ning Validation: ' 6/~'kF. I <br /> <br />FOR CITY US~E ~ <br /> <br /> CO D rrrvDIEVELOpMEmC W R <br /> 285 Church St. bilE- Room 132 k~'X~X <br /> <br /> 8:0~4:~pmPh~7X~1 ~klXl <br /> <br />B~DmG~App&i~ <br /> <br />RESID COMMERCIAL ~'~ Use of Structure: <br />( ( ) Relocation ( ) Addition ( ) New <br />()Alteration ()Other ()Alteration ()Sign ~/~*S/e~'~'~'~'~''~ <br />( )Accessory ( ) Change of Occupancy ( )Other <br /> <br /> ? I <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> ( ) 1 am th~ PROPERTY OWNER and own, msid~ in, ar will residein th~ completed structure and will ~ my o~ g~ ~. I uad¢~d ~t i mst m~mr ~ a cons~fion <br /> con~rac~or it'tl~ stm~am~ is sold or ~ far sale befor* or upon completion. If I hire subcontractors, I witl hire only subcontractors r~gistered with the Con~'uc~on Contractom <br /> <br />4. FEE SCHEDULE <br /> <br />(3) SUuetural Plan Review (.65% x Al) <br /> <br />TOTAL <br /> <br />=$ <br /> <br />I hereby certify that Ihe above information is cormt. <br />Permits are non-transfercable and expire if work is not started within 180 day s of issuance or if work is suspended for 180 days. <br /> <br />Name of Applicam (Please Print): <br /> <br />Signature of Applicant: <br /> <br />MC 15-73 Rev lP)5 <br /> <br />Phone: <br />Date: ~ <br /> <br /> <br />