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FOR CITY VALIDATION1 <br />Received By: <br /> <br />Date: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-t398 <br /> <br /> 24 HR Inspection Line 373-4427 <br />Office: phone 588-5147 8:00am - 4:30pm <br />FAX 5~-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 /> JOB ADDRESS <br /> <br />CITY <br /> <br />PROPERTY OWNER <br /> <br />OWNER'S <br />PHONE # <br /> <br />CROSS STREET/ <br />DIRECTIONS <br /> <br /> PROJECT DESCRIPTION <br /> <br /> P~S 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 />Mechanical Contzacter <br />Mailing Address City <br />PHONE <br /> <br />FAX -- <br />CONTRACTORS BOARD <br />REGISTRATION NO. <br /> <br />CONTRACTOR'S SIGNATURE <br /> <br />2E. FOR OWNER INSTALLATIONS <br /> <br /> Property Owner (please pdnt) <br /> <br /> Mailing Address <br /> <br /> City, State, 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 />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al below) <br />RESIDENTIAL ~1 COMMERCIAL [~ USE: <br /> <br /> GAS ~} ELECTRIC ~ <br />BASE FEE ASSESSED ON ALL APPLICATIONS $10.00 <br /> <br />5. FEES <br /> <br />Subtotal <br /> <br />TOTAL AMOUNT DUE <br /> <br />MC 15-41 7/97 <br /> <br /> <br />