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F~. CITY VALIDATIO-~0-~ MARION COUNTY BUILDING INSPECTION <br />,I .... ~'. ~/~ ~ d. 4'., COMMUNITYDEVELOPMENTCENTER <br /> {Received By: (.~~e..-- t%~ 255 Church St. NE - Room 132 <br /> L . .' .~, { <br /> IZoning Vahda~on: ~ S;00am-4:3~mPhone~8-,,4'/ <br /> ]Dnt~. /0 I'?--q~,, I 24 hr. lnmMn~on Lll~ S8{-7~4 <br />IDat~: ~} FAX S~-7~4a <br /> <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS <br />1. JOB DESCRIPTION <br /> <br />1 THROUGH 4 <br /> <br />) Relocation <br />) Other <br /> <br />RESIDENTIAL <br /> ) Addition <br /> <br /> ) Alteration <br /> <br /> ) Accessory <br /> <br /> ( ) <br />Alteration ( ) Sign <br />) Change of Occupancy ( )Other <br /> <br />~,~r~y paoc -- L ~o. s~ees: F~istlng - Sew- <br /> <br />Square Footage -Ba~ment: ~Main Floor~ooc j Garage: <br /> <br /> FOR CITY USE ONLY <br /> <br /> City 5~ack <br /> <br /> ~w.t: <br /> <br />~ of ~: <br /> <br /> /offi7o <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Subdivision <br /> <br />Mobile Home Park <br /> <br />'m A,:,:,mo. S7 g'ol - '7 ~'~, <br /> <br />~~gR ~.Wi~N:~ I~LEASE INDICATE WHO IS DOING THE WORK <br /> I am the PROPERTY OWNER and own, reside in, or will reside in the completed struclur~ and will he my own general ce~lracto~. I underhand that (mint register u a comtmctl <br /> conuactor if the stzucture is sold or offered for sale hefon~ o~ upon completion. If t hi~e subcontractors, ! will him o~ly suheomr~'tms rogistead with the Consu~ction Conuact~s Board. <br /> <br />4. FEE SCHEDULE <br /> <br /> o. ~ ~ o~j~.) <br /> <br /> (2) 5% S~ S~h~ <br /> <br /> (3) S~cm~ H~ Renew (.~ x Al) <br /> <br />(2) lw,~sli$~inn F~ <br />(3) Rdnspoctinn F~ · ~EI.S.00 <br /> <br />(4) Offer h~tioaa ~ list~l Jbove <br /> <br />-s O <br /> <br />I hereby certify that the above information is cormat, <br />Permits at~ non.transferrable and axp~ if WOrk is not started within 180 days of issuance or if work is susPended for 180 days. <br /> <br /> <br />