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Property <br /> Owner: <br /> Moiling Address', <br /> <br />ress; Site No.; Cross Street: <br />Mechanical Installer; Phone: Address: <br /> <br />Home Builder'~ Registration No.: <br />Residential; Commercial: <br /> <br />Now: <br /> <br />Use of Building: <br /> <br />Alteration: [] Addition; [] Relocation; <br /> <br />Occupancy Change: [] <br /> <br />~ ....... NO, FEE AMOUNT <br />Base Price 10,00 <br />Fomed ~ir furnace 100,000 I~',U or le3s 6.00 <br />Forced air furnace over ,100,000 E~'U 7.50 <br />~'St~'~pended Heater 6.00 <br />Wall Heater 6.00 <br />Floor Mounted Unit Heater 6,00 <br />Heat Pump 6,00 <br />Air Handling Unit to 10,000 cu. fl. 4.,50 <br />Ai~r .H,an dlin g'"U nit Over 101000 CU. !!, 7.50 <br />EvaporatJv~ Cooler 4.50 <br />Exha~,s! System Commercial 4.50 <br />Domestic Range Hoods 4,50 <br />~)0masdc Exhe, u~'Fene & Or~ar Vents 3.00 <br />of each wood Stove 7.50 <br /> <br />Commem~el or Industrial Incinerator <br />Fire Damper <br />Gee Water Heater <br />~or each gas piping system of up to <br /> 4 outlets, minimum fee <br />For each gas piping system of 5 or more <br />Outlets, per outlet <br /> <br />Appliance or accessory to any heating or <br /> Oomfert senJJt3g syste~l not covered <br />Other (as per Mochan[col Code); <br /> <br />On-Site Technical Review <br /> (Apply at Marion Co. only) <br />Reinspectioo Fee <br /> <br /> FEE <br />STATE SURCHARGE <br />PLAN REVIEW FEE <br />INVESTIGATION FEE <br />FLEETSURCHARGE <br /> <br /> TOTAL <br /> <br /> Please return COMPLETE APPLICATION with the indicated/lee. <br /> <br />1 am a registered buirder OR ( ) tho authorized representative of SIGNATU RE OF APPLICANT: ~ <br /> <br />Other <br />t agree to install aoc0~ing to the submitted plans and specifications, the laws of the state Of Orego~ and the o~na~ces of Mabon County, <br /> <br />MC 15-41 <br />Rev. 3/87 <br /> <br /> <br />