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FOR CITY VALIDATION <br />Received by:__ <br />Date:, '""'""i <br /> <br />MECHANICAL PERMff APPLICATION <br />P/ease aomplete ali Sections, 1 through $ <br /> <br /> ,mON COUST¥ BmLr mG msx CTiO ' U_e <br /> <br /> S~, OR 97301 SEP <br /> Date: <br /> <br /> ~Hr In~n L~ 5S~7~ MARI01~ OOUNTY <br /> Issu~; <br /> O~ 58~5147 8:~a~. =4:30p+m. DUILUII~ <br /> F~: 588-79~ <br /> <br /> ~ ~ $~ {Complete ~d ent~ ~tal M Al below) <br /> <br /> ~8ID~I~ ~ COMM~CI~ <br /> USE OF ~RUCT~: <br /> N~ ~ ~TION ~ ~D~O~OCATION ~ <br /> GAS ~ or ~E~IC ~ <br /> <br /> B~ F~ $10,~ <br /> <br />1. LOCATION OF I[N.qTALLATiON <br /> <br />PERMIT~ ARE NON-TRANSFER,ABLE Alq~ [~KPIP,~ I~ WO~ IS N~ <br /> ST~ ~ 1 ~ DAYS OF ~SU~ OR ~ <br /> wo~ I$ $U$~ ~OR 180 DAYS. <br /> <br />~. CO--ACTOR ~LA~ON O~Y <br /> <br />2B. FOR OWlqltR. I~iTAi,LATIONS <br /> <br />Property Owner (please pr2~) <br /> <br />Mailing Addr~s Phone <br />City/State/Zip <br />OWner's Signature: <br /> <br /> 3. PLANRtiVII~W SlqCTION <br /> <br />l ,a£,on Coan, not.req,,i,e a plaa <br /> We will provide plan review service if you complete <br /> Section 5B and submit two (2) sets of plans and <br /> pecifications.with this application. <br />tgi7 IY-41 <br />/~,v. 12/94 <br /> <br />FORCED AiR FIYRNACE <br />up Io 100,O00 BTU $ 6.00 __ <br /> ov~r 100,000 BTU $ 7.00 __ <br /> <br />Floor Furnace $ 6.00 <br />Suai~nded H~ater $ 6.00 <br />Wall Heater $ 6,00 <br />FlOOr Mountad ne:~r $ 6,00 <br /> <br />IffiAT pIJMp <br />uader 3 Ton $ 6.50 __ <br />3 Ton and up $ I 1-00 __ <br /> <br />Au~ co~omort~a <br />under 3 Ton $ 6.50 <br />3 Ton ~d up $11,~ ~ <br /> <br />~ial ~t Sys~m $ 4,~ ~ <br />~mcsfic K~gc H~ $ 4,~ ~ <br /> <br /> ~d ~ec V~m $ 3.~ ..... <br />~m Damper $ 7.~ ~ <br /> <br />ADDITIONAL APPLIANCE,'t <br />Oa~ Water Heater $ 7.50 <br />Gm Log Lighter $ 7.50 <br />Gas Baeb~qua $ 7J0 <br />Odter $ 7,50 <br /> <br />OAS PIPINO SYSTEM <br />1-4 oatleta (per outlet) $ 2.00 <br />4 mid up oudata (per outlet) $ 50 <br /> <br /> tm appliance permit $ 3,00 <br />OTF~ZR (~$ ceqoiced by Btdl~Jt~ Off'ciaO <br /> <br /> Al. F. nt~ total o£ fo:.a from Sec.//4 <br /> <br /> B, [mteg 25% of lin~ Al for plan <br /> iAI * .25). if mqu'u~d <br /> ¢. Inv~atlgafion Fee (if requital) $ <br /> D. R~imp~lion Fee ($25.00) <br /> <br /> · OTaL aMOUnt <br /> <br /> <br />