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FOR CI.TY VALIDATION <br />Zoning Vali?tion: ~ [ <br /> <br /> ~ ::;:~ :~:L0~E& ~WO~Y,D~LLING PE~T APPelATION <br /> ,~ .,:, ~ .... , *I~cludes ele~a~ ~han~ag, p!gmbing fee~ <br />CO~LETE ALL $~TIONS, 1 ~ROUGH 4 <br /> <br /> ( ~,~mp~ ~RION COUN~ <br />2, LOCAT]Q~OF:~STAI~!)T!ON <br /> <br /> ) ci~ <br /> <br /> ] am ~ A~O~D ~8E~ATIVE of the ~e~ o~ or c~mr. <br /> <br />MARION COUNTY BUILDING INSPECTION I FOR CITY USE ONLY <br /> ' COMMUNITY DEVELOPMENT CENTER I <br /> 285 Church St. NE - Room !32 Cit~ S~b~ck R~uim~m~: <br />. ~ .... ~!C~,~n97~01 I' .~ . ~ <br /> '":~': ~ ; ~S;~,~,Z~:%6mrbro"eSSS.'~I~'7: [~ ~D- fi-,: <br /> FAX 588-'794S I ' o' <br /> <br />4. FEE SCHEDULE <br /> <br />Ao <br /> <br />VALUATION - Based on sc!ua~ footage: <br /> <br />B. PERMIT FEES <br /> <br /> State Surcharge <br />3. Plan Review Fe~ <br /> ,_.:_ <br /> <br />TOTAL $.345 PER ~ ~ <br /> <br />Dwelling labels must be obtained at Marion County Building Inspection and must be placed at the jobsite prior to InsP~cflon for plumbing, electrical and <br />mechanical work. Contact Marion County for instructions. <br /> <br />I hereby certify that the above information is correct. Permits am nondransfercable and expire if work is not started within 180 days of issuance or if work is susp~ldcd for <br />180 days. <br />NameofApplicant(PloasePrlnO: f~ ~ /,~/~ Phone: ~7~//~- ~//Z~Z <br /> <br />MC 15-80 Rev 1/96 <br /> <br /> <br />