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FOR CITY VALIDATION <br />Received By: <br /> <br />Da~: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR InSlnction Line 37~.4427 <br />Office: phoae 588-5147 g:00am - 4:30pm <br />FAX 588-7948 <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />TAX ACCOUNT NO. <br /> <br />,oB <br /> <br />PROP~ O~R <br /> <br />C"ms S~Tt ~ <br /> <br />PRo cr D SC ,noN / gD/770/.9 <br /> <br />PERMrrs ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WlTI-HN 180 DAYS OF ISSUANCE OR 1F <br /> I <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />FAX --. ,~, <br />CONTRACTORS BO~ <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Property Owner (please prin0 <br /> <br /> Mailing Address <br /> <br /> City, S~ate. Zip <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: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in A1 below) <br />RESIDENTIAL ~. COMMERCIAL {~ USE:, <br />~ f'l ALTF.~,AT1ON~ ADDmON O P'I~OCATION ~ Pu~ULACE ~ <br /> · d~ O ~Ec~c ~ <br />BASE FEE ASSF3SED ON ALL APPLICATIONS $10.00 <br /> <br />FORCED AIR UP TO ]00,000 BTU <br /> <br />DUCTS (ALTERATION/EXTI~qSION) <br /> <br />GAS FiP~.~L AC EYINSE RT <br /> <br /> Each outlet up to 4 outlets <br /> <br />NE~TE~ <br /> <br />3 TON AND MORE $ x sn.0o <br /> <br />5. FEES <br /> <br /> A2. Add 5% surcharge (.05 x Al) $ ~ <br /> Subto~ $ <br /> <br />B. Enter 25% of li~ A1 for Plat Review <br /> (Al + .25). ff requ~ed <br />C. Investigation Fee (if r~qalred) <br />D. Ralnspectlon Fee ($25.C~) <br /> <br />Receipt No. <br /> <br />TOTAL AMOUNT DUE <br /> <br />MC 15~1 7/97 <br /> <br /> <br />