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FOR .CITY VALIDATION MARION COUNTY BUILDING INSPECTION <br /> .~/ ~ 285 Church St. NE - Ro~m132 <br /> I~eceJ~ed By: __ COMMUNITY DEVELOPMENT CEN'TF.R <br /> <br />Zoning V~ation: I lJ//f,,~ ~ S~m, Ot~ <br /> <br />iDate:.. :[S I~b'~v 24 hr. In~eaon Lin~ ~-'tg~l <br /> ~ WI)/ FAX <br /> <br /> BUILDING PERMIT APPLICATION <br /> <br />FOR CITY USE ONLY <br /> <br />1. JOB DESCRIPTION <br /> <br />RESIDE~ITI AL COMMERCIAL U~ of Sm;crate: -~ <br />(~)Addition ( )Relocation ( )Addition ( )New ~f{-I~.q~/df..=~, S~_ .t.~/,/~ <br /> Alteration (~) Olher ( ) Alteration ( ) Sign ~ ~) ~ <br /> Acces~W ( )Ch~ge of~u~cy ( )~er <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />4. FEE SCHEDULE <br /> <br />A. <br /> <br />=$ <br /> <br />Nam~ofApplicant<Plca~ePdnt): ...T~ ~l ~B~--'~--~ Phone: <br /> <br /> <br />