Laserfiche WebLink
FOR CITY USE ONLY <br /> <br />FOR CITY VALIDATION MARION COUNTY BUILDING~INSPECTION <br />I ., '~]- / COMMUNITY DE~OPME~ <br /> ~f.~2 285 Church St NE - Re City Setback Requirements: <br /> P.~e~ved By' f~t ~ J~ , . .o~ <br /> ~ ' ~.~ s.,~.o,~o.~/l~ (~ ~n,: ' %: /0 ,' <br /> <br /> BUILD~G PE~IT ~~ ,_ ~ <br /> <br />n DESO.I'TION <br /> <br />R~ESIDENTIAL COMMERCIAL ' e of gtruetu~: <br />( ) Addition ( ) Relocation ( ) Addition ( ) New /'O~S.~ [o~/~- ~ ~- ~ <br /> ( ) Alteration ( ) Other ( ) Altmtion ( ) Sign <br /> ( ~ccesso~ ( )C~geof~cupancy ( )Other <br /> <br />2. LOCATION OF INSTALLATION ' ,~,tw~ "~"~t ~' G'7~' 7 ! <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATEiWHO IS DOING THE WORK <br /> <br />4. FEESCHEDULE <br /> <br />A. VALUATION (See "Valuation Schedule" to d~rmln~ valuation <br /> <br />(1) Additional Plml Rcvicws or Addendums <br />(2) Inve.qtigafion Fee <br /> <br />'ro?^L :$ ~bT, 37~ <br /> <br />I hereby cortlfy that the above information is cam:ct. <br />Permits are non-transferrable and expire if work is not started within 180 day; of issu~ce or if work is sus~nd~d for 180 days, <br />Name of Applic~t (Please Print): ~~~~. mi ~r~ ~oae: ~ ~ ~~' ~. <br />Signature of App ~ .Date: ~ ~ <br />MC 15-23 Rev 1/95 <br /> <br /> <br />