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FOR CIT~ VALIDATION MARION COUNTYiBUILDiNG INSPECTION [ FOR CITY USE ONLY <br /> ~4 /- COMMUNITY ?EVELOPMENT CI~NTER [ -- -- -- <br />Received By. [~.~ ~ //dj~dl,~2 285 Chu~h St, N~ - ~ 132 [City geth~k Requi~ment~: <br /> <br />Zoning Validation: ~ s+OOam-4'3~m PhoJ~/~ ~ IF~u /~ ' [~e~: / ~ <br /> <br /> BUILDING PE~IT APP~ON ~/I/I <br /> <br />RESIDfiNTIAL COMMERCIAL "'~ /~ <br />( ) Addition ( ) Relocation ( ) Addition ( ) New <br />( ) Almmtion ( ) Other ( ) Alteration ( ) Sign <br />(~Accesso~ ( ) Change of Occupancy ( ) Other <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Lm Width ,~e~'- / Lot Depth ~ Acres ~[ Lo} ~ Corner ~ Community Well ( / City <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE iNDICATE jWHO IS DOING THE WORK <br /> <br />T lin an AUTIIORIZED R~PKESENTAT~ of the @m@etty owner or contractor. <br /> <br />/ 7// <br /> <br />4. FEE SCHEDULE <br /> <br />Ae <br /> <br />on ~qnar¢ footage of projt,~t.) Valuation: $ <br /> <br />]~. Miscell~.neous Fees <br /> <br /> (1) Additional Plan Revitw~ or A&lendums <br /> <br /> (2) Inwstigation F** <br /> <br /> (3) l~insp~;tion F~ @ $25.0t) <br /> <br /> (4) Othe~ Inspe~ons not listed above <br /> <br />=$ <br /> <br />TOTAL =$ O~..~.4P/ <br /> <br />Permits are non-tr0nsfcrrabIe and expire if work is not started within 180 days of i!suance or if work is suspended for 180 days. <br />N ¢ofApplicant(PleasePrint):. ,~,~~'2/~ ~~ ~ Phon~; <br /> <br /> <br />