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FOR CITY VALIDATION] <br />Received by: <br />DateL <br /> <br />MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 LANCASTER DR NE - SUITE C <br />SALEM OREGON 97305-1398 <br /> <br />0 fll~l~l~l-~fl~l~)O a .m. _ 4:3 0 p .m. Issued by: <br /> $88-7948 <br /> <br />Date: <br /> <br />IMECHANICAL PERMITAPPLICATId~¥11 ~ ~99~ [ 4 FnnSCHED <br /> / [ . ~,I'LE (Complele and shier ~lal in A I helow) <br /> P/ease complete ~1 S~tlons, 1 throu~b.~,du ~nuNTYI <br /> <br /> ~/ ~~ ~ GAS ~ or ELE~IC O <br /> <br />PERMITS ARE HON-TRAHSFERABLE AND EXPIRE IF WORK 15 HOT <br /> STARTED WITlnN 180 DAY5 OF ISSUANCE OR IF <br /> WORK 15 SUSPENDED FOR t 80 DAYS. <br /> <br />21t. FOR OWNER INSTALLATIONS <br /> <br />Properly Owner (plesse print) <br /> <br />Mailing Address <br /> <br />FORCED AIR FURNACE <br />op lo 100,(~0 BTU $ 6.00 <br />over I00,000 B'IT0 $ 7.00 <br /> <br />F~oor Furnace $ 6.00 <br /> <br /> nEAT PUMp <br /> m~der 3 Ton $ 6.50 <br /> 3 Ton and .p ~ $ I 1.00 <br /> AIR CONDITIONER <br /> under 3 Ton $ 6.50 <br /> 3 Ton and ttp $11.00 <br /> <br />_ Don~ R~.t[~-~d ~ _ $ 4.50 <br /> ~d ~ Vents S 3.~ <br /> <br />ADDITIONAL APPLIANCES <br />Gna Water Ilealcr $ 7.50 <br />Oas Log Lighter $ 7.50 __ <br /> <br />$ 2.00 <br />$ .50 <br /> <br />$ 3.00 <br /> <br /># of Labels 3'1/C_ <br /> <br />3. PLANRBVIItW 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 />specificatlens with this application. <br /> <br />5. FB1]5 <br /> A I. Enter Iotsl of fees from Sec.//4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> (Al + .25}, if requlr~d <br />C. lnvesligatlon Fee (i f requlred) <br />D. Relnnpe¢ilon lee ($25.00) <br /> <br /> TOTAL AMOUI'~ DUE <br /> <br /> <br />