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FOR CITY !VALIDATION MARION COUNTY BUILDING INSPECTION [ FOR CITY USE ONLY <br /> ~- "~ - .o · [ - .~,~ COMMUNITY DEVELOPMENT ~ [ <br /> ReceivedBv' ~ wg~ ~ 285 Chuwh $1. NE- Room!r~)~ii;l~...' ~. ]Cityg~b~kRe~ui~nmm: <br /> <br />COMPLETE ALL SECTIONS., THROUGH 4 <br /> <br />1. JOB DESCRIPTION <br /> <br />RESIDENTIAL COMMERCIAL 'Use of <br />( ) Alteration ( ) Other ( ) Alteration ( ) Sign <br />( ~A~cccessoqt ( ) Change of Occupancy ( ) Other <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />( ) I ara an AUTHORIZED REPRESENTATIVE of tho properly own*r or contractor. <br /> <br />N'am¢ <br /> <br />4. FEE SCHEDULE <br /> <br />A. <br /> <br />VALUATION ($e~ "Valuation ~chedal¢" to determ~ valuation <br /> <br />on square footage of project.) Val~lation: $ <br />(1) Permit Fee ~ <br /> <br />=$ <br /> <br />I hereby certify that the above iaformation is correct. <br />Permits are nan-transferrable and expire if wo[k is not started within 180 d~ys of issuance or if work ia suspem~%d for tgO day~. <br /> <br />MC 15-73 Rev t/95 <br /> <br /> <br />