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Received By: <br />Date: <br /> <br />FOR CITY VALIDATION <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> MARl <br />1. LOCATION OF INSTALLATION <br /> <br />IJOB ADDRESS ,9, lq07 OO~ Li,.} <br /> crrY O O ~'0r'Ct <br /> <br />cross STeEr/ <br />DIRECTIONS <br /> <br />pROJECT DESCRIPTION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK 1S SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br />IPropexty O~vner (pleaseprinO <br /> <br />Owner's Signature <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 p!ans and <br />specifications with this application. <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br /> 24 HR Inspeetio~il~ln~ <br />Office: FAX ~ <br /> phone 588-Sl~lI~l~pm <br /> <br /> 4. FEE SCHEDULE (~mplem ~ en~r ~1 in A1 ~Low) <br /> <br />5. FEES <br />Al, Enter total of fees from Svc, #4 <br />A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br />B. Enter 25% of line Al for Phm Rcvlew <br />(Al + .25), if mqui~ed <br /> <br />Receipt No. __ <br /> <br />MC 15-41 7/97 <br /> <br /> <br />