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[FOR CI~T~ VALIDATION MARION COUNTY BUILDIN~.~NJPECTION I FOR CITY USE ONLY 1 <br />I ~ ..~ . .. ~ COMMUNITY DEVBLOPMEN~J~*i~t~ I I <br />IReceived s,. I <br />Izon,., Validation: ~,~ g:00~-4:Z0pml'ho~~'''/;~ ~ ~ ~'~ O' ]~.~r. / ~, I <br />....... ~AXSSS.~4S ~A/~ . - ~'rn'l ~ ~ I ~* /~ I <br /> B~D~G PE~ APPLI~' ]~9? ~ <br />CO~LE~ ~L SEC~ONS. 1 THROUGH 4 ~[~,,._ C0~ <br /> <br />L JOri I I q 'ECr/ON <br /> <br /> RESIDENTIAL COMMERCIAL Use of S 'teuctu~: <br /> (~Addition ( )Relocation ( )Addflion ( )New ~O/-~C)~ <br /> ( ) Alteration ( ) Olher ( ) Alteration ( ) Sign <br /> ( )Accessory ( )ChaageofOccupancy ( )Other <br />Descdpaon of Work I ls this a hlstodcnl building? V~ - ~ <br />Energy Path: ] No. Stories [No. of Employe~s: Exisling - New- [No. B edzooms: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Subdivision L~t Block <br /> , ~we~ ( ) S~ ~ <br />~w~ ~ ~ //~ ' A~, ~'~ ~ i ~w~, () ~ <br /> <br />3. CONTRACTOR INFORMATION m PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />( ) I ara thc P.R. OP~RTY O.~.. and own, rc~idc in, or will reside in the c. ompleted s~ a~ ~u ~ my ~n;s~ ~. I ~d ~ i ~ ~ ~ a ~ <br /> contrac*or If ti~ str, tctm~ ts sold or offered fo~ salc before or upon conq~on. If [ hire subcontractor. I v,ill hil~ on~ ~ ~ ~ ~ ~ ~ ~. <br /> <br />4. FEE SCHEDULE <br /> <br />on square fool~ of project.) Valuation: <br />(1) Permit Fee <br />(2) 5% State Sx~charge (.05 x Al) <br /> <br />(6) Seismic Suxch~ge . 7/, <br /> <br />(2) {nvesti~ion l~e <br /> <br />(3) Reinsl~ l~e · $~,00 <br /> <br />I hereby certify that the above information is correct. : <br />Pcxmits are non-traasferrable and expire if WOrk ls rn0t stalled within 150 d~YS Of issuance or if work is suspended for 180 days. <br /> <br /> <br />