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FOR CITY VALIDATION <br />Received By: . <br />Date: _ <br /> <br />MARION COUNTY <br />BUILDING INSPECTION DIVISION <br /> 3150 Lanczzter Dr. NE - Suite C <br /> Salen~ <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />MECHANICAL PERMIT APPLICATI( <br />Please complete all Sections, 1 through <br /> <br />1. LOCATION OF INSTALLATION <br />TAX ACCOUNT NO, <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <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 /> Age~nt'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 /> atal in A1 below) <br /> C OMME RC~L~ {~ USE: <br /> ADDITIO?~ RELOCATION [] REPLACE [] <br /> GAS {~ ELECTRIC {~ <br />BASE FEE ASSESSED ON ALL APPLICATIONS $10.00 <br /> <br /> FURNACE OTY <br /> FORCED AIR UP TO 100,000BTU x $6.00 =$ <br /> FORCED ALR OVER IC0,0O0BTU x S7.00 =$ <br /> <br /> FLOOR FURNACE x $6.00 = $ __ <br /> DUCTS (ALTERATION/EXTENSION) x $7.50 = $ <br /> GAS INSTALLATIONS <br /> GAS FURNACE (up to [g0,000 BTU) x $6.00 = $ <br />GAS FURNACE (over 100,000 BTU) x $7.00 = $ __ <br />GAS FIREPLACE/INSERT x $7.50 -- $ <br />GAS WATER HEATER x $7.50 = $ <br />GAS LOG LIGHTER x $7.50 = $ __ <br />GAS BARBEQUE x $7.50 = $ __ <br /> <br />GAS PIPING <br />Each outlet up to 4 outlets x $2.~0 =$ __ <br />Each a0ditional outlet over 4 outlets x $.50 = $ <br /> <br />HEATERS <br />SUSPENDED HEATER x $6.00 --$ <br />WALL HEATER x $6.00 = $ <br />P'LOOR MOUNTED x $6.00 = $ <br />ItEAT_P_LL~E <br />UNDER 3 TON x $6.50 = $ <br />3 TON AND MORE x $11.00 $ <br /> <br />N/C <br /> <br />5. FEES Al. Enter total of fees from Sec. <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />B. Enter 25% of line A1 for Plan Review <br /> (Al + .25), if required <br />C. Investigafon Fee (if required) <br />D. Reinspection Fee ($25.00) <br /> <br />Re~i~ No. <br /> <br />Subtotal <br /> <br />TOTAL AMOUNT DUE <br /> <br />MC 15-41 7/97 <br /> <br /> <br />