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~.-~FOg ~TY VALIDATION/ MARION COMMUNn~pMEmCOUN'I"~UILDINGcENT~INSPECTION ~FOR CITY USE ONLY <br />[Received B y: .~ [ 285 C.h ~lf~lAr~/~a~132 City S~b~k <br />Zoning Validation: .~ ~ 8.~- <br /> I <br /> .taLI,I G q 3- (I 3 0 <br />CO~LE~ ALL S~ONS. 1 T~ROUG~ 4 ~ ~ .."' ~10. C~, ~T~/~ <br />1. JOB DESC~ION ~/N~ <br /> <br />RESIDENTIAL COMMERCIAL ~' ~ ] ~0/~/ Um of Structure: <br />(~ddition ( ) Relocation ( ) Addition ( ) New <br />( )Alteration ( )Other ( )Alteration ( )Sign ~t~-~~-'~- <br />( )Accessory ( )ChengeofOccupancy ( )Other <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Job Address ~, ~ ~.~ ~ ~j~/, '"{%~o T.x Acct. No. ~ S~ ~ ~ <br />MobilcHom~P~k ~}~ ~ ~ Sp~ / ~ <br /> <br />~tWid~ ~ ~p~ ~ Ac~s l~g.~ Co~ ~i~We~ ( ) ~ <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />4. FEESCHEDULE <br /> <br />on square footsge of project.) <br />(1) Peri.it Fee <br /> <br />(2) 5% S~ate Surcharge (.05 x Al) <br /> <br />(3) Struevaral Plan Revivw (.65% x Al) <br /> <br />(4) Fire & Life Safety Plan Review (.40% x Al) <br /> <br />(5) ' ' ' ~ (.~5% x Al) <br /> <br />(6) Seismic Surcharge~s'~')' S~'~'- <br /> <br />1, 93 <br /> <br /> (2) Investigation <br /> <br /> (3) R~insp~cfion <br /> <br />P~CE1PT: <br /> <br />I hereby certify that the above information is correct, <br />Permits are non-transferrable and expire if wc~k is not s~med within 180 days of issuance or if work is suspendexl for 180 days. <br /> <br />  Phone: <br />Signatu~ of Applicant: Date: <br /> <br />MC 15-73 Rev U95 <br /> <br /> <br />