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~ ] MARION COUNTY BUILDING INSPECTION <br />FOR CI~ USE O~qLY ~ COMM~ DEVE~PMENT CEN~R <br />R~ivod By: D~: [ 31~0 ~n~r ~. NE-Sui~C, Sal~, ~on 97305 <br />~n~g By: City: . ~ g~O ~ - 4:30 pm <br /> <br />pE. RMITS ~ NON-TRA$fSFERABLE AIWD ~IP, E IF WORK <br />l$ NOT STARTED WITHIN 180 DA Y~ OF ISSUANCE OR IF <br />WORK I$ SUSPENDED FOR 180 DA I~. <br /> <br />· iA. CONTRACTOR INFORMATION -- PLEA$E LNDICATE WHO IS <br /> DO hNG TH~ WORK <br /> <br />Mailing Address: <br />Ci~': $1.~e: Zip: <br />Pho~: Fax: <br /> <br />[ am the PROPERTY OILIER and own. mzlde i~ or will reside in the <br />aomplered structure and will be my own general contractor. ! understand <br /> <br />offered for $a1¢ before or upon compl~ior~ Ill hire gubcontractor~ I will <br />[f' ff change my mind and do tdre a general contractor who is regietered nith <br />the Construction Contracior~ BoarcL [ will immedio~ly notify Mrtrrion Coun~ <br /> <br /> Owner's Sig~eture: <br /> <br /> Agent's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br />4. FEE SCHEDULE (complete and enmr total in A I } <br /> <br /> ,RE~IDEN'YiAL ( )COMMERCIAL <br /> ) NEW ( ) ADDITION <br /> ) RELOCATION ~ REPLACEMENT <br /> <br />Fu~ace (includea duets I vents) <br /> <br />FIoo~ Furnace <br /> <br />( ) GA,~ ( ) ELEC'IRIC <br />( ) ALTERATION <br /> <br />QTY <br /> <br />x $15.00 <br /> <br />C-as <br /> <br /> $12.00 = <br />x 515.00 <br />x 515.00 <br />x $15.00 <br /> $15.00 <br /> 515.00 <br /> <br />4.00 <br />L00 <br /> <br />Heaters <br />Suapended Heater <br />Wall Heater <br />~Ioor Moun~d Heater <br /> <br />$12.00 = $ <br />$12.00 = $ <br /> <br />522.00 = $ <br /> <br />Air Conditioner <br />Under 3 Ton <br />3 Ton and More <br />Evapora~ve Cooler <br /> <br />· ., x $15.00 = $ <br /> x $ 9,00 ~ $ <br /> <br />$ 9.00 ~ <br />$ 9.00 ~ <br />$9.00-- <br />56.00-- <br />$ 6.00 = <br /> <br />x $ 6.00 = S <br /> <br />Addltlmml <br />Woodetova / Firaplae~ <br />Fir~ Damper <br />Coral / Lndu~al <br /> <br />· . x $15.00 ~ $ <br /> x $ 6.00 = $ <br /> ~: $60.00= $ <br /> <br />One/Two Family l)weUing Fee Squa~ Feet: x S .04 = $ <br />D~elllng Permit Labels #of Labels (~ S N/C <br />(For New Dwellings Only) <br />Other (m rcqui~d by the Building OIticial) S <br /> <br />FEE~ <br /> <br /> (minimum one hour) 5 -- <br /> 'tOTAL AMOUN'r t~UE <br /> <br /> <br />