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IFOR~CI.TY VALIDATION{ MARION COUNTY BWILDING INSPECTION FOR CITY USE ONLY <br />Re,eib'ed By: ~ COMMUNITY DEVBLOPMENT CENTER <br /> 285 Church St. NE ~32 City Setback ReXlOJ foments: <br />IZ° n v d ti°": - I <br /> <br /> PERMIT APPLICBt~N ~ - - _~ . <br /> co~tU'm A~ sr. cno~s, ~ 'muov~a ~ <br /> 1. JOB DESCRIPTION q <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Lot Width: O'-/ <br /> <br />3. CONTRACTOR INFORMATION ~ PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />J~B sinesaName: / . ~d~g'~/Ft~/~' Regisa'etionNo,: <br /> <br /> Mai ' A s' Phone' <br /> <br />4. FEE SCHEDULE <br /> <br />B. Additional Inspection/ <br /> (beyond third ins~efion) <br /> Re~nspeefion Fee <br /> <br />$60.00 = <br /> <br />I hereby certify that the above information is coxreet. Permits are non-transferrable and expire if work is not s~a~ted within 180 days of issuance <br />or if work is suspended for i80 days. , <br /> <br />MC 15-64 Rev3/95 <br /> <br /> <br />