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FOR Ct~TY VALIDATION MARION COUNTY BU~.TION FOR CITY USE ONLY <br />~ningV~idatio~: r~ [ 8:~.:~p~?~) ~ ' ~/ m: /0' ~: /o~ <br />Date' <br /> <br />CO~LE~ ~L SEC~ONS, 1 T~OUGH 4 <br /> <br />1. JOB DESC~ION <br /> <br /> RESID~/~I,TIAL COMMERCIAL Us~ of Stmetere: <br /> (v3 Addition ( ) Relocation ( ) Addition ( ) New <br /> ( ) Alteration ( ) Other ( ) Alteration ( ) Sign <br /> ( )Accessory ( )ChangeofOccupancy ( )Other <br /> <br />.gquareFootag~-aasement: ] Main Floor: .. i I <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> () <br /> <br /> ( ~ I am an AUTHORIZED REPRESENTATIVE of the property owner or contractor. <br /> Mall ng Address <br /> <br />4. FEE SCHEDULE <br />A. B. Mismllan~ous ~ <br /> <br />VALUATION (See "V M uatieaa Schedule" to d~t, rmi~ valuation bas~l <br />on square footage of project.) Vaiuaticm $ ~6)O <br /> <br />( 1 ) Permit <br />(2) 5% Sta~ Sumharge (.05 x Al) <br />(3) Stmcturai Plan Review (,65% x Al) . = <br /> <br /> Zonlng Surcharg if applicab[6 {.05% x Al <br /> <br />(6) Seismic Surcharge <br /> <br />.$ <br /> <br />I hereby certify that the above information is correct. <br />Permits are non-transferrable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days, <br /> <br />MC 15-73 Rev 1195 <br /> <br /> <br />