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FOR CITY vALIDATION <br />Re~ived by: <br />Dst©; <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete ali Sections, I through 5 <br /> <br />L LOCATION OF n']STALLATION <br /> <br /> Job Address ,.~- <br /> <br /> ...... I ~'~:~ -~-"~3---q <br /> <br /> ~c4,, % ~9: ~,,,,,,,,,,,,,,P ;m :~ <br /> <br />]P~MIT$ A~ NON-~AN$~B~ AND ~ ~ WORK 18 NOT <br /> STAR~ W~IN 1 ~ DAYS OF ISSUAN~ OR IF <br /> WO~ IS SU$~D~ ~OR 1~ DAYS, <br /> <br /> 2A. CO~RACTOR ~ST~LATION O~Y <br /> <br /> ~mracmr', Lieens* No, ~q <br /> Contractor's Boa~ Rcg~ No, ~[~ ~- Job No. ~ <br /> ~n~¢wt% Slgnatu~~ ~ <br /> <br />Mailing Add~ <br /> <br />City/State/Zip <br /> <br />Owner's Signattm:: <br /> <br />MA OS coum'Y <br /> COMMUNITY DEVELO_.~ C'~ <br /> 285 Church St N~I~¢~ '1-3~ <br /> <br /> O~ 5a8 5147 a-~ a m -~; ~ $$U~ ~y: <br /> : ' ' ' "~ uUU~TY <br /> F~: saa-79~iLDiN8 ;~SPFCT~3~ <br /> 4. FB~ SCHWAB (Complote and eat~ total in A1 below) <br /> <br /> USE OF STRUCT~E: ~ ,.~ <br /> NE~ ~L~RATION ~D~ION <br /> GAS ~ or ELE~RI~ <br /> No. X F~ ~ Sum <br /> BASE FEE <br /> <br />3. PLAN P. BViEW SECTION <br /> <br /> Marion 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 />specitications with this application. <br /> <br />MC 15-41 <br /> <br />FORCED AIR FURNACI~ <br />up to 100,000 BTU $ 6.00 <br />over 100,000 BTU ~ $ 7D0 <br /> <br />Floor Furnace $ 6,00 -- <br />Suspended Heater ............ $ 6.00 -- <br />Wall Heater $ 6.00 -- <br />FloorMountcd Hoatet $ 6,00 -- <br /> <br />HRAT PUMP <br />talder 3 Ton $ 6.50 <br />3 Ton and up ], ii $I 1.00 <br /> <br />AIR CONDITIONRR <br />trader 3 Ton $ 6,50 <br />3 Ton and up ~-- $11,00 <br /> <br />EvaporativeC~I*t $ 4.50 <br />~m~sti¢ R~ge HO~ $ 4,50 <br /> <br />ADDITIONAL APPLIANCES <br />Ga Watar Hgater $ 7.50 -- <br /> Gas Log Lighter $ 7.50 <br /> Gas Barbeque $ 7,50 -- <br /> Oth~ $ 730 -- <br /> <br />GAS PIP1NO SYSTEM <br /> 14 outlets (per outle0 <br /> 4 and up outle~ (per outlet) <br /> <br />OTHER (its required by Builc~'ng Ol~ial) <br /> <br />DWgLLING PERM~ L~EL ~ of ~la <br /> <br />$ .§0., <br /> <br />$ 3,00 -- <br /> <br />5. FEES <br />Al. Enter total of fee~ from Se,~. #4 $ <br />A2. Add 5% aumharg~ (.05 x A 1) $~ <br /> <br /> B. ~nter23% of lineAl tbrPl~ Rcvlew <br /> (A 1 * ,25), if ~qu[md <br /> ~. Investigation Fee (ifmqui~g) <br /> <br /> TOT~ mO~ DUE S <br /> <br /> <br />