Laserfiche WebLink
FOR C~ITY VALIDATION MAroON cOu~TYiBUILDING ~NSPECTION <br /> <br />Date:~S-- / - ~h~., <br /> <br />FOR CITY USE ONLY <br /> <br />COMPLETE ALL SECTIONS, I THROUGH 4 OD <br />L JOB DESCRIPTION ~-~-"-/~:~'~ <br /> <br /> RESIDENTIAL, COMMERCIAL'~'~'ff.O/~.~"I¥~I'~/)' "4 ~rVs~ofg~tu~: <br /> ( ) Alteration ( ) Other ( ) Alteration ~n /~ ,~ ~ t <br /> (~Accesso~ ( )Ch~geofOc~u~lcy ( )Other <br /> <br />~"~"~':te:,:~`'''; I'''"'°°': I~'°""~,: ......... I"?~: x~o I o~: t'*"" /~' ........... <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION- PLEASE INDICATE WHO IS DOING THE WORK <br /> ( ) <br /> <br />4. FEE SCHEDULE , <br />A. I B, Misv:llm¢ou~ F~.s <br /> <br />(2) $% State Surcharge 605 × A I ) <br />(3) Structural Plan Review 665% x Al) ~v- <br /> <br />Valuation: <br /> <br />(1) Additional Plan P,~vlews or Addenduma = $ <br /> <br />TOTAL =$ ~2. ~.~/' <br /> <br />[ hereby certify that the above infbrmation is correct, <br />Permits are non-transtgrrable and expire if work is not ~tarted within 180 daya of ~sl,~ance or if work i* ~uspended for lg0 days. <br /> <br />Name of Applicant (Please P ~ ~ i Phone: <br />Signature of Applicam: ~Date: <br />MC 15-73 Rev 1/95 <br /> <br /> <br />