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Mechanical Permit Application Appl. Recd: ~ MARION COUNTY Mechanical Permit Application DEPT, OF BUILDING INSPECTION SenatOr Building # 225 220 High St., N.E. 2nd Floor Bldg. Permit No Salem, Oregon 97301 R.H. WITHROW, BLDG. ADMINISTRATOR Mechanical Permit NO.._ 4~6 ..... 588~5147 -- 588-514~ 10/13/83 Date: 5:00 P.M.- .......... CODE.A-Phone 588,5373 ............. 8:00 A,M. Type of Permit: ~,)~0 ~q (~r" ~/(~ ~' ~ ~ Tax Lot No: Bldr. & No.: Phone: Address: Phone: Address: Plans. by: ~ New Installation {~ Replacement Application is made for: [] Addition Appliance (~.j~/~i~v f'~ 7~Ci~, BTU ~npu~ F~oor A~, ~ Ven~ Si~e Fu~ ComlTtentsL Approved By; Date: Gas Connection iTEM NO, FEE ~MOUN~ For Issuance ct Permit = ;i0;00 New Inst~ll. L~ 1000,000 STU~' ....... 6,0~ Replacement Ls 100.~00 BTu 6,00 Ne? Install_ Mor~OO~OO~BTU ' ~., ~eplacement More 1~,~ BT~ ~ : : 6;00:: New Install Floor. F-r .... " 6,00 ~ 6,00 · :er ~- ~r 6.00 -" ~,o~ .oo er 6,00 ~ ~ ..... ~,oo .... YU ~ ~.00 _ STU ~ ~,oo ITU 22.50 000 ~TU ' ~ 37.5b ~. ' ; 4,50 ~ ft. 7.50 4.50 4,50 ~dus{ri~lin3iner~tor : = : : 30.00 ~as connection w~/hou~ Ap~uan~e (~ to 4 each): Comton Coo~ing S~stem Nm ~o~ed ~ove 4,50 I agree tO inata//according to the submitted plans and specifications, Marion County. Permit expires if work not commenced w/thin 120 days. I further expressl~ slons of ORS 701.005 to 701.125 because: ( ) I am a registered conlractor or ( ) the authorized representative of e ~ The work will be performed I am performing work on a property I own ( ) Other (p/ease specify) SIGNATURE