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MARION COUNTY <br /> <br /> FOR CITY VALIDATION BUILDING3150 LancasterINSPECTIONDr. NE - SuiteDIVISIONc PERMIT NO: <br /> Received By: Salem, Oregon 97305-1398/ <br /> Date <br /> Date: 24 HR Inspection Line 37~1427 <br /> Office: phone 588-S147 8:09~n - 4:30pm., Issued by: <br /> <br /> MECHANICAL PERMIT APPLICATION E SCHE.D~LE (Complct= ~d enter total in A1 ~low) <br /> Please complete all Sections, 1 through 5 'JUl 3 ~ ~ ~'~SF~N~L ~ CO~,maCU~L C~ USE=__ _ <br />· ' - ] ~ ALTERATION ~ ~DDj~T1ON ~ RELOCATION ~ REPLACE ~ <br />1. LOCATION OF INSTALLATION MA~]0~ ~O[j~]-~t ~ o^s~ £LeCZmC t~ <br /> , , , , , , , 'n'~|'~;i~, i~l p~.S~ASSESS~ONAC~Am'UC~O~S $10.00 <br /> ~ACC°'~'~°'I I I I I I.--I .I-r -~,'~'; ~ =$.tJ~ <br /> FOECED AIR UP TO 100,000 BTUx $6.00 <br /> <br /> DIDI:31'-I r/Iq-lq'l-I l I I01t <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED V~ITHIN 180 DAYS OF ISSUANCE OR Ilc <br /> WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2B. FOR OWNER INSTA~ rlONS ' <br /> Property Owner (please print) <br /> <br /> Mailing Address <br /> <br /> Cty, State, Zip <br /> <br />Owner's Signature <br /> <br />Agent's Signature <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 />$7.0O = $ __ <br />x $6.0O --$ <br /> <br /> $7.00 =$__ <br />x $7.50 =$$~ <br /> $7.50 <br /> $7.50 = $ __ <br /> $7.50 -- $ __ <br /> <br /> $3,0o <br /> <br /> x $.50 =$__ <br /> <br />x $6.0O = $ __ <br />x $6.00 -- $ <br />x $6.00 = $ __ <br /> <br />x $6.50 -- $ __ <br />x SILO0 $ __ <br /> <br /> x $4.50 = $ __ <br /> <br /> x $4.50 = $ __ <br /> x $4.50 -- $ <br /> x $4.50 -- $ <br /> x $3.00 =$ -- <br /> x $3.0O =$ <br /> <br />x $3.0O = $ __ <br /> <br />x $7.50 --$ __ <br />x $3.00 =$ <br />x $30.00 = $ <br /> <br />~o ]~AiE E~nSter total of fees from Sec, h~ ///.~U / <br /> B' (~;tt¢ r+ .2255)%, i°ff r~ealr~e~f°r Plan Re~ <br /> <br />C. tevesaga~on Fee (ff required) <br />V. Re'inspection Fee ($25.00) <br /> TOTAL A-MOUNT DUE <br />Receipt No. <br /> <br /># of Labels N/C <br /> <br />MC 15-41 7,n97 <br /> <br /> <br />