Laserfiche WebLink
FOR CITY VALIDATION <br />R~i~ed <br /> <br />Date: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br /> 3150 Lancas~' Dr. NE - Suite C <br /> Salem, Or. gon 97305-1398 <br /> <br /> 24 HR Insl~-~ion Line 37:~427 <br />Office: phone $88-5147 8:00am - 4:30pm <br />FAX 588-7948 <br /> <br />NO: .. 7.s'A9 <br /> <br />Issued by: <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete afl Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> CR~S S~/ <br /> <br />PERMITS ARE NON-TRANSFFJIABLE 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 />biecha~'tca[ Contractor <br />Mailing Address City <br /> <br />PHONE ~ ~ <br />FAX -- ~ <br />CONTRACTORS BOARD <br />REGISTRATION NO. <br /> <br />CONTRACTOR'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 />4; FEE SCHEDULE (Comp~t~ rnd enter total in Al ~l~) <br />~WE~L ~ CO~RC~L ~ ~: <br />~ ~ ~0N ~ ~Dm~ ~ ~A~0N ~ ~ ~ <br /> <br />BASE ~E ASS~D ON A~ ~P~CATIONS $10.~ <br /> <br />Al. Ent~ total of fees from Sec. g4 <br />A2. Add 5% surcharge (.05 x Al) Subt°ad~ <br /> <br />C' lnvestig~i°~ Fee (if reqmmd) <br />D' ReinsPecfion Fee ($25.00) <br /> YOTAL AMOUNT <br />Receipt No. <br /> <br /> <br />