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WED 14:2S FAX i S03 ~8 7948 <br /> <br /> ~IARION BLDG INSP [~003 <br /> <br /> FOR CITY USE ONLY <br /> ~ Ci~ Setbacks: <br /> <br /> 24 la', Inspc~fion Line 373-4427 ! $- iai <br />......... Fax ~8~-7~4s ......... ~ ~'~ ' <br /> <br /> BUILDING PERMIT. APPLICATION <br /> <br /> ~OR t:l t x USE ONLY ~ MARION COL']~I~ BUll,DING ~SP~ION <br /> <br /> ~ By: c~: [ 3150 ~t~ ~. ~ - S~e C <br /> ~c~t~: ~:$~ [ , ~,.~0n'97305 · . <br />............................... 2 : . · · $:~am.,4 ~0~ <br /> <br />1. JOB DESCRIPTION <br /> <br />~qm ~:o~ge: BM~v'a~ ~~. la Floo~ I{oOC) ~1r. 2nd Floor: bi/t, <br /> <br />2. LOCATION O]~ INSTALLATION . <br /> <br />CONTRACTOR II~IFORMATION -- I~LEA,~ INblCAT~, WHO Is ~IN~ THE WO~ <br /> <br /> ~t~ w~l ~c ~ ~n~Gton ~ If I ~ my m~ ~ do h~e a g~.cO~Cl~ who ~ ~l~e~ ~ ~ ~9~on ~ <br /> <br /> Phon6: <br />4. ]FEES <br /> <br /> VALUATiON(See Valuation S~hcdule to d~tea'm~ne the. valuation <br />base4 on s9 ,u?re fantage of the pr0j ~ct) 5' ~:-F~ ~ ..'. <br /> <br />.B, Misc~d!~cotm F~e~ · <br /> <br /> TOTAL <br />[ hereby certil}' that thc above ial'ormation is cOre,ct .Perr~s are non-tl~sferrable alld expire if work is not $~ax[ within 180 tla~ of issum~ce or i.f wolk <br />suspended for 180 days. <br />Ntnnc ofAppliczat [Pleo.*~ Print]:.., C..t~_u~. 'pl.~a 1,%%~/',l~L~ ~ NOTICE <br /> Mailin§ Ad&css: 2."/ol ~ V,~t~4~ '~6-r_ '/1~.: Po~..n.a,~ .OR '~l~-tl~; EFFECTIVE 7-! <br /> l'hone:~ · alq. 'l~X~ , STATE SURCHARGE CHANGE - <br />Signature of Applicant: <br />.MC 15-7~ l~'v 9/95 ~ FROM 5% TO '/% - <br /> <br /> <br />