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'FOR CITY VALIDATION MARION COUNTY BUILDING INSPECTION <br />~,ivoa By: ' ,~t~ ~.~_ ~,~.- -/~-'k~:l COMMUN1TY2g5 Chu~hDEVELOPMENTst. NE - Room CENT~;Ri~2 <br /> ' /ff ~l ~ ' -- ' ' '~ -~ ~'~ ..... <br /> <br /> BUILDING <br /> <br />FOR C,?Y USE ONLY <br /> <br />I..iOB DESCRIPTION BUILDING INSPECTION <br /> <br />Addition ( ) Relocation ( ) Addition ( ) New <br />Al~ration ( ) Other ( ) Alteration ( ) Sign <br />ACC.SSO~ (~an~. of ~cupancy ( ) Other <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WI-IO IS DOING THE WORK <br /> <br />1 am :tn AUTHORIZED REPRESENTATIVE of thc property owner or contractor. <br /> <br />4. FEE SCltEDULE <br /> <br /> (2) Investigation Fee <br /> <br /> (3) Rr, inspe~tion Fee ~ $25.00 <br /> <br />~zcstvr: ¢/& O <br /> <br />'I'OTAL = $ ~> ~ <br /> <br />I hereby certify that the above information is correct, <br />Permits are non-lrans ferrable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days, <br /> <br />MC. 1s.73 Rev 1/95 <br /> <br /> <br />