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MARION COUNTY BUILDING INSPECTION/~)'~/?~, COMMUNITY DEVELOPMENT CENTER <br />FOR <br /> CITY <br />~e vad hw I Date: <br /> <br /> PIece complete ~1S~tions, I through 5 [ R~SlDE~I~ <br /> USE OF ~aUCTURe: <br /> <br />LOCATION OF INSTALLATION <br /> <br />I>~fipfion/Ddirectom <br /> <br />~ PERMITS ARE NON-TRANSFERABLE AND ~,Z[PIRE IF WORK IS NOT <br /> STARTED WITHIN IS0 DAYS OF ISSUAblCE OR IF <br /> WORK I$ SUSPFm'qD~D FOR I~O DAYS. <br /> <br /> 2A, CONTRACTOR I~STALLATION ONLY <br /> <br />, ._., ' p,o,,, 57:J-%n qql <br /> <br /> Contractor's Signaltffi~! ........ ~cr' ' <br /> Z" . 7- <br /> <br />~B. FOR. OWIxlItR. INSTALLATIONS <br />PiDpcrly Owner {plc~e pritg) <br />Mailing Addmu~ ' Phone <br /> <br />City/Staw-~Zip <br /> <br />Agent's Signature: <br /> <br /> 3. PLAiN[REVIEW SECTION <br /> <br /> Mario~ County does not require a plan review. <br /> We will provide plan review service if you complete <br />[ Section 5B and submit two (2) sets of plans and <br />[specifications with ,his application. <br />MC 15-41 <br /> <br />NEW rq ALTERATION El ADDITION ~1RELq)CATION U <br /> <br />GAS ~ or ELECTRIC <br /> <br />FORCED AIR FURNACE <br /> np lo 100,000 BTU <br /> ove¢ lDO,000 BTU <br /> <br />Wall Beater <br /> <br />No, X Pt~ ~ <br /> <br />......... $ 6.00 -- <br /> $ 7,00 <br /> <br />$ 6,00 --- <br /> <br />$ 6,oo __ <br />$ 6.oo __ <br /> <br />BEAT PUMP <br /> under 3 Ton <br /> <br />AIR CONDITIONER trader 3 Ton <br /> <br />E¥ apotali'~¢Cvol~t <br /> <br />Cianmerelal Hood and Exha~t <br />~mestic Range Hood <br /> <br />$ 6.50 <br />$11,/30 <br /> <br />$ 6.50 Q 50 <br />SH.00 ...... <br /> <br />$4,50 -- <br />$ 4.50 <br />$4.5o __ <br />$ 4.50 <br /> <br />$ 3.00 -- <br />$ 7.5X~ ~--- <br />$ 7.50 .... <br />$30,00 <br /> <br />ADDITIONAL APPLIANCES <br /> <br /> Gas [~og Lighter <br /> Gas natbcqu¢ <br /> <br />GA8 PIPING SyStEM 1-4 oull¢la (per outlet) <br /> 4 and up outlels (p~r outle0 <br /> <br />Appliance Vents not included itl <br /> <br />OTH ER (as required by Buildd~ Ol~¢ia 0 <br />DWELLING ~ LABgL <br /> <br />$ 7.50 <br />$ 7,50 ,.-- <br />$ 7.50 ~.~ <br />$7.50 -- <br /> <br /> $ ZOO <br /> $ 30 ___ <br /> <br /> $ B.o0 <br /> <br />g of Label~ ~C <br /> <br />5. FEES <br /> <br /> A2, Add 5% aurehatg~ (,05 x Al) <br /> <br />$ <br /> <br />B. ERt¢r 25% of line Al lbr Plan Review <br /> (A 1 + .25), if required <br />C. Inwstigution Fee (if required) <br />D, R,inspection Fat> ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br />Rec¢ipl No. <br /> <br /> <br />