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Received By._ Date: <br />Zoning By: City:. <br />Receipt #: Amount'S <br /> <br />[MECHANICAL PERMIT APPLICATION ] <br />1. LOCATION OF INSTALIL~TION <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />3150 Lanca~er Dr. lqE - Sase C, Sakm, Oregon 97305 <br />8:00 am -4:30 pm <br />24 Iff. Inspection Line 3734427 FAX588-7948 <br /> <br />Parcel ID: <br /> <br />2A. CONTRACTOR INFORMATION -- PLEASE INDICAIE WltO IlS <br /> <br /> ! <br /> <br />I am the PROPERTY OW3tER and own. reside i~. or will reside in the <br />completed structure and will be my ~wn general contractor. 1 understand <br />that 1 m:ast register as a construction contractor if the ~ucture is sold or <br />offered for sale before or upon complenon. Ill hire subcontractors. I will <br />hire on~ subcontractors registered with the ConSruction Contractors Board. <br />Ill change my mind and do hire a general contractor who is registered with <br />the Con$~rmzfion Contractors Board. I will immediately noti~. Marion County <br />of the ~ame bf the contractor: <br /> <br /> Owner's Signalure: <br /> <br /> Aglmt'$ Sigmmre- <br />3. PLAN REYIEW SECIION <br /> <br />4. FEE SCHEDULE {complete ami enter tats1 ia Al) <br /> <br />(/) RESIDENTIAL (.)~(~OMMERCIAL ( ) GAS t ) ELECTRIC <br />~ RELOCATION /~'~EPLACEMENT t <br /> <br />Gas Fumac~ (up to 100,000 BIO) <br />Gas Furnace (over 100,000 BTU) <br />Gas Fkephee / ln~:a <br /> <br />Gas Log Lighter <br />Gas Bad~que <br /> <br />Gas Piping <br /> <br />x $12.00 = <br /> x 515.00 <br /> x Sl 5.00 <br /> x $15.00 <br /> x 515.00 <br /> x 515.00 <br /> <br />x $ 4.00 = $ <br />x $ 1.00 = $ <br /> <br />x $12 DO <br />x $12.00 <br />x $12,00 <br /> <br />3 Ton and More <br /> <br />x $12.00 = $ <br />x $22.00 = $ <br /> <br />Uede~ 3 Ton <br />3 Ton and Mine <br /> <br />Co,al Ldm~t System <br />Coral Hoed & Exhaust <br /> <br /> x Sl 5.00 <br /> x $22.00 <br /> x <br /> <br /> x $ 9.00 <br /> x $ 9.00 = <br /> x $ 9.00= $ <br /> x $ 6.00 = <br /> x $ 6.00 <br /> <br /> x $ 630 = <br /> <br />__ x $15.00 <br /> x $ 6.00 <br /> x $6~.00 <br /> <br /> x $ .04 <br /> <br />MC i541Rev9/g8 <br /> <br /> <br />