Laserfiche WebLink
FOR CITY VALIDATION <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, I THROUGH 4 <br /> <br />[' FO___~R CIT~__~_ USE~ONL~Y <br />FrI~ ine,, [[} i Rear-., <br /> <br />JOB DESCRIPTION <br /> <br />RESIDENTIAl. ~OMMF~RCIAL Use of Structure: '-- <br />( ) Addition ( ) Relocation ( ) Addition (~) New <br />( ) Alteration ( ) Other ( ) Alt*ration ] ( ) Sign <br />(~ Accessory ( ) Change of Oceu?~cy ( )Oth*r IglYg5i <br /> <br />LOCATION OF INSTALLATION <br /> <br /> !, <br />3. CONT~CTOR IN~O~TION ~ PLEASE INDICATE ~O IS DOING T~ WORK <br /> <br />() <br /> <br />MatiingAdd~tts ~ ..~/~g¢~,~_ <br /> <br />4. FEE SCHEDULE <br />A. <br /> <br />Ilo squar~ gooutge of pmj~t.) Valuation: $ '~ <br /> a~, ~-~ J (l) Additional Plan Reviews or Ad0~ndum~ <br /> <br />(2) $% State Surcharge (,05 x Al) <br /> <br />: oZa,~ <br /> <br />-___ z.bb_ <br /> <br />I hereby certify that the above information is con'eat, <br /> <br />Nam¢ofApplicant(PleasePrio0: ~{~ .t'"O i; i Phons:.7 ,477vq <br />McSigaatur¢ of Applicant:is_73 Rev 1/95 ----~ ~Date: ~ ~. <br /> <br />TOTAL <br /> <br />:, P_2.. 3'/ <br /> <br /> <br />