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MARLO <br />~UILOIN( <br /> <br />OM~/IUNII~Ip~ELOPM ENT CENTER <br />%-~28~5~aC.nhur-~lfNE · Room 132 <br /> <br /> Date: <br />OUNlaspection Line 3*3-4427 <br />~l~t~litgl~,~88-S147 8:00am - 4:30pm Issued by: <br />oreo ! IUI~X: $88-7948 <br /> <br />IMECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />pERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED W1THnq 180 DAYS OF ISSUANCE OR IF <br /> WORK lS SUSPENDED FOR 180 DAYS. <br /> <br />City/State/Zip <br /> <br />Owl~r's Signatt~'~: <br /> <br />Agent's Signature: <br /> <br />4. FBB SCHEDULE (Complate and ent~ total in A1 b~low) <br /> <br /> RE~IDENTI ,AI~ COMMBRCIAL ~ <br /> USE OF STRUCTURe: ' <br /> NEW O ALTERATION ~ ADDITION,//~RELOCATION <br /> GAS O or ELECTRIC O <br /> No. X F~ = 8am <br />BASE FEE $10.~0 <br /> <br />FORCED ~ Ii'Oi~ACIt · <br />upto 100,000 BTU $ 6,00 <br />over 100,000 BTU $ 7.00 <br /> <br />Flcor Furnace $ 6.00 <br />Suspended Heater $ 6.00 <br />Wall Heater $ 6.00 -- <br />FloorMeuntedHeat~r $ 6,00 -- <br /> <br />HEAT PUMP <br /> under 3 Ton <br /> 3 Tonand up <br /> <br />AIR CONDITIONER <br /> under 3 Ton <br /> 3 Ton and up <br /> <br /> and D~r Veins <br /> <br />Wood Stove/lqr6pmco <br /> <br />$ 6.50 <br />$1t.O0 <br /> <br />$ 6.50 -- <br />$11.00 <br /> <br />$ 4.50 <br />$ 4.50 <br />$4.5O -- <br />$4.50 <br /> <br />$ 3.00 -- <br />$ 3.00 <br />$7.5O '~ <br />$7.50 <br />$30.00 <br /> <br />$ 7.50 <br />$7.50 <br />$ 7.50 <br />$7.5O <br /> <br />OAS PIPING SySTeM <br /> 1-4 oude~s (per outlet) <br /> 4 and up outle~ (p~r outlet) <br /> <br />Appliance Vents not included in <br />an appliance p~nnit <br /> <br />OTHER (as r~tuirod by Buildit~g OINeial} <br /> <br />DWELLnqO PERMIT LABEL # of Labels <br /> <br />$ 2.00 <br />$ 3O <br /> <br />$ 3.00 <br /> <br />N/C <br /> <br />3. PLANREVIBW 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 />specifications with this application. <br /> <br />~C 1541 <br />rEV 8/96 <br /> <br />5. FEES <br />A 1. Enter total of fees from Se~.//4 $=L~-~ <br />.4.2. Add 5% surcharge (.05 x Al) <br /> <br /> (Al + .25), if nxluired $ e----- <br /> D. Roinsgection F~ ($25.00) $ ~ <br /> <br /> TOTAL AMOUNT DUE g,~ngd, 4[ <br /> <br /> <br />