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FOR CITY VALIDATION Received b~ Dato: Please complete all Sections, 1 throuO'}~'~ EP"I 1. LOCATION OF INSTALLATION MARION BUILDING Ir c~ ,~ ~ MARION COUN~. Y RLRLDING INSPECTION Salem, DBte: 24 hr. Inspection Line 373-4427 4. HE, DIJL~ (Complete ~d cnt~ ~ml ~ Al below) ~SIDE~I~ ~ COMMERCI~ ~ ITyN~ ~ AL~RATION ~ ~D~ION ~ R~OCATION ~ ~T~S ~ or ELEC~IC ~ BASE FEE $10.~ WOR~ 1S SU~D ~ORq80 DAYS. 2,A. COi~I'RACTOR INSTALLATION ONLY Contractor's License No. FORCED AIR FURNACE up to 100,000 BTU $ 6.00 -- over 100,000 BTU $ 7,00 Fk~rFumaee $ 6.00 -- Suspended Heater ~ $ 6.00 IZ,O0 Wall Heater $ 6.00 __ Floor Mounted Heater $ 6.00 __ HEAT pUMp under 3 Ton $ 6.50 -- 3 Ton ~nd up - $[L00 AIR COHDITIOI~R tmd~r 3 Ton $ 6.50 __ 3Tonand up $11.00 -- EvaporativeCooler $ 4.50 __ Commercial Exhaust System $ 4,50 -- Commercial Hood and Exhaust $ 4,50 -- Domestic Range Hood $ 4.50 -- Gas Watar Heater / $ 7.50 GAS PIPING SYSTEM 1-4 outlets (per ou0et) ~ $ 2.00 Appliance Vents not ineleded in an appliancepermit $ 3.00 -- OTHER (as tvquired by Buil~g Official) DWELLING PERMIT LABEL # of Labels 5. F~ES Al. Enter total of fees from Sec.//4 A2, Add 5% sm~charge (,05 x A 1) Subtotal N/C I~ogeay Owner 6o/e~ s~ pri~) Mailing Address Phone City/State/Zip Owner's Signature: . Agent's Slgnamre: 3. PLANRBVIEW SECTION Marion County does not require a plan review. I We will provide plan review service if you complete I Section 5B and submit mo (2) sets of plans and I specifications with this application. MC 1541 REV gig6 B, Enter25% of lineAl for Plan Revisw (Al + .25), it'required $ C. Investigation Fee (if r~quircd) $ D. Reimpection Fee ($25.C0) $ __ TOTAL AMOUNT DUE $. ~ 3,0~O Receipt No.