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FOR CITY VALIDATIONI <br />Received By: <br /> <br />Date: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Loncaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> 24 HR Inspection Liae 373-4427 <br />Office: phone 588-5147 8:00ara -4:30pm <br />FAX 588-7948 <br /> <br />TAX ACCOUNT NO. <br />JOB ^DDP~SS ,/'ill 7)~bi'~) ~ <br /> <br />CROSS ST~ET/ <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT I <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> I <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br />IProperty Owner (please print) <br /> <br /> Owner's Signature <br /> <br /> Agent's Signature <br /> <br />3. PLAN REVIEW 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 />PERMIT NO: ~ q-- 08%/~ <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter tokai in Al below) <br />RESIDENTIAL O COMMERCIAL [~ USE: <br /> <br /> NEW [] ALTERATION ~ ADDITION ~ RELOCATION <br /> GAS {~ ELECTRIC {~ <br /> <br />HEA~RS <br /> <br />Subtotal <br /> <br />5. FEES Al. Enter total of fees from Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />B. Enler 25% of line A 1 for Plan Review <br />(Al + .25), if required $ <br />C. Investigation Fee (if r~qu[red) $ <br />D. Reinspection Fee ($25.00) $ <br /> TOTAL AMOUNT DUE $ ~ <br />Receipt No.. <br /> <br />MC 15-41 7/97 <br /> <br /> <br />