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FOR CITY VALIDATION <br />Received by:. <br />Date: <br /> <br />MARION COUNTY BUILDING INSPBCTION <br /> COMMUNITY DEVELOPM.~N~ PERMR* NO: <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all ~ectione, I through 5 <br /> <br />MARLO' <br />BUILDING <br /> <br />1. LOCATION OF I~STALLATION <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />/ q'7 o3 <br /> <br />2B. FOR OWNI]~ INSTALLATIONS <br />Peopetty Owner (ple~se print) <br /> <br />City/Stele/Zip <br /> <br />Owner's <br /> <br />A~nt's $ignetum: <br /> <br />FAX: 588-7948 <br /> ~ (iOUNTY <br /> ~]~I)UL~ (Complete md ~ ~ ~ A [ below) <br /> RESIDE~I~.. COMMBRC~ Q <br /> us~ o~ ~u~; ~w~t k~ <br /> ~W~ ~ON ~D~[ON~OCA~ONa <br /> GAS ~ ~ ~]C~ ~ ~ <br /> No, X Pm <br /> <br />BASE FEE <br /> <br />FORCED AIR P 12RNACE <br /> up to 1O0,0O0 BTU <br /> over 1O0,000 BTU <br /> <br />Floor Furnace <br /> <br />$ 6.00 <br />$ 7.O0 <br /> <br />$ §.O0 __ <br />$ 6.0O __ <br />$ 6.OO <br />$ 6,00 <br /> <br />$11.00 -- <br /> <br />$ 6.50 __ <br />$11,O0 -- <br /> <br />$4.50 -- <br />$4.50 -- <br />$4.50 <br />$4.50 <br /> <br />$ 3.O0 <br />$ 3.O0 <br />$7.50 -- <br />$ 7,5O -- <br />$3O.O0 -- <br /> <br />ADDITIONAL APPLIANCES <br /> Gas Water Heater <br /> Gas Log Lighter <br /> Gas <br /> OIh~r <br /> <br />$ 7.50 -- <br />$ 7.5O -- <br />$ 7.5O <br />$7.50 <br /> <br />GAS PIPING SYSTEM <br /> 1-4 outlets (per outlet) <br /> 4 and up outlets (per outlet) <br /> <br />OTHER (as required by Buildit~ Ol~isl) <br /> <br />$ .50 -- <br /> <br />$ 3,O0 <br /> <br />N/C <br /> <br /> 3. PLANRBVIBW 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 />I specifications with this application. <br /> <br />Al. Enter Iotsl of fee, s f~nn Sec. g4 <br />A~. Add 5% sur~ha~e (.05 x Al) <br /> ~ubtotal <br /> <br />B. Eater25% of lineal for Plan Review <br />(Al + .25), if required $.__ <br />C. Investigation Fee (if r~quired) $.__ <br />D. Reimpection Fee ($25.00) $.__ <br /> TOTAL AMOUNT DU~ $ 17 ~';-~ ~ <br />Receipt No. <br /> <br /> <br />