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Date <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />MECHANICAL PERMIT APPLICATION <br /> <br />Owne,' T ..,¢ ¢ <br /> (~ .~ <br /> <br />S~tus Address <br />Mech,_an~ic.al Installer ~ , j, <br /> <br />Home Budder=s Registration No <br /> <br />Phone <br /> <br />sileho <br /> <br />Phone <br /> <br />Address '. / ~ ,- <br />Cross Street ) ~ <br /> <br />Address <br /> 3 <br /> <br />Residential <br /> <br />New ~ <br /> <br />Base PHce <br />Forced air furnace 100=000 BTU or less <br />Forced air furnace over 100=000 BTU <br />Floor Furnace <br /> <br />Suspended Heater <br />Wall Heater <br />Floor Mounted Unit Heater <br /> <br />Air Handling Unit to 10 000 cuft <br /> <br />A~r Handtin§ Umf over 10.000 cuft <br /> <br />Exhaust System Commercial <br /> <br />Commercial <br /> <br /> j Use of Building <br />.1 <br /> <br />Occup~nr:y Change Li <br /> <br />Domestic Range Hoods <br /> <br />Domestic Wood Stove <br /> <br />AMOUNT <br /> 10 00 <br /> <br /> NO AMOUNT <br /> <br />Commeroal ~)r Industrial Incinerator 130~311~- -------I <br />-¥,r}b~,*pe7 ..... ____. 3 co '~.-_ <br /> ' --- 26~- ....... <br /> Gas Connection w!e AppliC-tnce (1-4 each) ] 250~ <br /> o~,er 4. $8 00 plus ea addnl <br /> Appliance or accessory to any heating or '- ~qnJ- ~ ~ <br /> Comfort cooling system not covered .... 1~_~,~ oO <br /> / <br /> On,Site Technical Review ---- <br /> iApply at Marion Co only) <br /> R ,?~_,,_,,_,,,_, F~,, _ ........ --_-~' <br /> FEE $ <br /> STATE SURCHARGE <br /> PLAN REVIEW FEE $ <br /> INVESTIGATION FEE <br /> FLEET SURCHARGE $ <br /> CfTY FEE --~ <br /> TOTAL $ ' <br /> <br />Please return COMPLETE APPLICATION with the indicated fee <br /> <br />Other <br /> <br />Rev 3t87 <br /> <br /> <br />