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PERMIT NO: <br /> <br /> ~ MARION COUNTY <br /> x, , ! BUILDING INSPECTION DIVISION <br /> \' OR CITY VALIDATION ] 3t~o Lancaster Dr. NE- Suite C <br /> \ .... Salem. Oregon 97305-1398 <br /> ~ ~ece,vea ~y: __ I <br /> t~ Dat~: -- ] 24 HR Inspection Line 373-44'17 <br /> ' .~7 ] Office: pholte 588-5147 S:OOam - 4:30pm <br /> ~l FAX 588-794~ <br /> <br /> MEc.^.,c^. PE..,T I <br />r~ ] Please complete all Sections, I through 5 I <br />~,~,/~t 1. LOCATION OF INSTALLATION <br />\ <br /> <br /> Idol} I-Igb Ig I-1 6 <br /> <br /> ST~D ~ 180 DAYS OF ISSU~CE OR WO~ IS SUSP~ ~R 180 DAYS. <br /> <br />2A. CONT~C~R ~STALLA~ON ONLY <br /> <br /> Mailing Ad~. ~ ]~ g~g ~ ~ city <br /> <br />2B. FOR OW~R ~8TALLA~ONS <br /> <br /> ~y Ow~ ~le$e <br /> <br /> ~ent's Signature <br /> <br />3. PLAN REVIEW SECTION <br /> Marion County does not require a plan review. I <br /> We will provide plan review service if you complete <br /> Section 5B and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />Issu~by: <br /> <br />4. FEE SCHEI~U~LE (Complet~ and enter total in Al below) <br />~Sm~mAL ~, 'COMMERCIAL {~ USE:__- <br />~ [~ AUF~.ATI0~ ~ ADDm0N <br /> GAS X ELECTRIC <br />BASE FEE ASSESSED ON ALL APPLICATIONS <br /> <br />x :~.00 =$__ <br />x $7.00 = $ -- <br /> <br />x $6.00 = $ <br />x$7~0 =$ <br /> <br />x $6.00 =$ <br /> <br />x $7.~0 <br />x $7.~0 = $ <br />x $7.ffi =$__ <br />x $7,~0 =$ <br /> <br />x $6.00 =$ <br />x $6.00 =$ <br />x $6.00 =$ <br /> <br />x $6,50 = $ -- <br /> <br />x $6.50 <br /> <br />x $4.50 <br /> <br />x $4.5O = $ <br />x $4.50 = $ -- <br />x $4.50 =$__ <br />x $3,00 =$ <br />x $3.00 = $ -- <br /> <br />x $7.50 = $ <br />x $3.00 =$ <br />x $30.00 = $ <br /> <br />5. FEES Al. Enter mta[ of f~cs from Sec. ~4 <br /> A2, Add 5% surcharge (.05 x Al) <br /> <br />B. Enter 25% of line A1 for Plan Review <br /> (Al + .25), ff required <br />C, Investigation Fee (if required) <br />D. Reinspcclion Fee ($25.00) <br /> <br />Receipt No. <br /> <br />Subtotal <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ - 2,5'u <br />$ <br /> <br />MC 15-41 7/97 <br /> <br /> <br />