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IRFOg'CIyY y LIDAT. ION <br />[Zoning Validation: <br /> <br />MARION COUNTY B~INGINSPECTION I FOR CITY USE ONLY <br /> 285 Church St. ~J~ '- Room, 132 ~ j~ { i/,C') ~ C-..~.{City Setlmek Rsqui~m~ts: <br /> <br /> Y98 ' ' '" <br /> <br />1. JOB DESCRIPTION <br /> <br />RESIDENTIAL COMMERCIAL U~ of Sm~ctum: <br />(~J~dition ( ) Relocation ( ) Addition ( ) New ~ <br />( ) Alteration ( ) Other ( ) Alte~'ation ( ) Sign <br />( )Accessory ( )ChangcofOccupancy ( )Other /~'.~.~,~ <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE J[NDICATE WHO IS DOING THE WORK <br /> <br /> ( ) I am the PROPERTY OWNER and own. r~ide in. ce will reside in the completed stmcmm and will b~ my own general ~. I understand that I mu~t r~giater ~ a construetio~ <br /> <br />(I) Permit Fee ~'O <br />(2) 3% State Surcharge (.05 x Al) -- ~q~ <br />(3) Structural Plan Review (.65% x Al) .a = ~ <br /> <br />=$ <br /> <br />I he.by certify that the above information is corce~t. <br />Permits are non-transferrable and expire if work is not stacsed within 180 days of issuance or if work is suspendeA for 180 days. <br /> <br />Naro-e of Applicant (P,eas¢~~' ~ ~) JL~t ~:~0 Phone:('N~-~ ~ <br />Signature of ^ppHcam: ~ Da,: <br />MC 15-73 Rev 1/95 <br /> <br /> <br />