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zoF .OR CLTY VALIDATION] <br />Received By: /~ <br /> ning Validation: <br /> <br />Date: <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. JOB DESCRIPTION <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> COMMUNITY DEVELOPMENT cENTER <br /> 285 Ch~h St. NE - Room 132 <br /> <br />BUILDING PEl~ A. PPLICA(IC~I~// <br /> <br /> Cob <br /> '~ /IV~p~ <br /> <br /> FOR CITY USE ONLY <br /> <br />~r~ i~, [~. I~' <br /> <br />(~difion ( ) Relocation ( ) Addition <br />( ) Alteration ( ) Other ( ) Alteration ( ) Sign <br />( )Accessory ( )ChaugeofOccupancy ( )Other <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> () <br /> <br />1 am an AUTHORIZED REPRESENTATIVE of the prol~fly owner or contza~Wr. <br /> <br /> 7b~.771tt.~ <br /> <br />4. FEE SCHEDULE <br /> <br />A. VALUATION (S~e "Valuation Schedule" to delermine valuation b,~ed <br /> <br />(2) hve~ipfio~ F~ <br /> <br />I hereby ce~ify that the above information is correct. <br />Permits are non-transferrable and expire if work is not started within 180 days of issuanc~ or if work is suspended for 180 days. <br /> <br />Name of Applicant (Plea~e~ ~/~o Phone: <br /> <br />MC 15-73 Rev 1/95 <br /> <br /> <br />