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FOR CITY VALIDATION <br />Received By: <br />Z~ning Validation! <br /> <br />COMPLETE ALL SECTIONS, ! THROUGH 4 <br /> <br />MARION COUNTY:BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Chu~h St, ~ - Room 132 <br /> <br /> FAX $88-7948 <br /> <br />BUILDING <br /> <br />FOR CITY USE ONLY <br /> <br />L .lOB DESCRIPTION <br /> <br /> RESIDENTIAL COMMERCIAL <br /> <br /> ( ) Addition ( ) Relocation ( ) Ad~tion <br /> ( ) Alteration ( ) Other ( ) Alteration <br /> ( Lb~cceasory ( ) Change of Oceu~cy <br /> <br />Squ~e F~ge -Basement: '] Main Flooe; I s~ond~l~E ' <br /> <br />) New <br /> <br />) Sign <br /> <br />) Other <br /> <br />MARION <br /> <br /> Ia thin a historical building? Yea - No <br />New - { No, Bedrooms,. <br /> 3'0O <br /> <br />2. LOCATION OF INSTALLATION ] q 7 Y .2 5'- <br /> <br /> ~ ~ ~vae Well ( > Spring <br />~tWldm~~ ~tVerm ' Ac~ ~g.~t ~ Co~ ~, Co~unityWall () City <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> ( ) <br /> <br />qgq'/O <br /> <br />4. FEE SCHEDULE ! <br />A. VALUATION (See "Valuation $chr, dule' to demtnline valuation based i · <br /> On square fo0tag~ of project.) Valuation: S .~o~/~ / <br /> <br />B, Miscellaneous Pee.q <br /> (l) Additional Plan R~viewa or Addendums <br /> <br /> (2) Inwstigadon Fee <br /> <br /> (3) Rcinapection F~e ~ $25,00 <br /> <br />=$__ <br /> <br />Name of Applicant (Plea ~} ~g~mO i Phone: <br /> , <br />Signature o f Applicant; ~ c.~- L..~,..,'j~ ~-£,~ ~Date: <br /> <br /> <br />