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FOR~?~TY VALIDATION MARION COUNTY BUILDING INSPECTION [, FOR CITY USE ONLY <br /> 285 Church St. NE - Room 132 City Setback R~quttemems: <br /> <br />~ ~ ~J I Right Side: <br />[Zoning Validation: <br /> <br /> BUmDING PE~ ~ICATIO~ / I] <br />COMPLETE ALL S~CTIONS, 1 THROUGH 4 <br /> <br />L wsc m <br /> <br />RESiDIRNTIAL COMMFeJ~CIAL '-",,-utat~ iNSp£2' r-use of st~4~. <br /> ( ) Addition ( ) Relocation ( ) A~tlon ( ) New U~ 0~ /~' ~ff' r ~ <br /> ( ) Alteration ( )~her ( )Alt~tion ( ) Sign <br /> ~Accesso~ ( )Ch~geofOccupancy ( ) O~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 />(2) Investi~fioa Fee <br />(3) Reinspectlon Fee ~ $25.00 <br /> <br />=$ <br /> <br />TOTAL =$ ~. :~ <br /> <br />Permits am non-transferrable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days, <br /> <br />Signature of ApplJca~ _Date: <br /> <br />MC 15-73 Rev 1195 <br /> <br /> <br />