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· ~ 3lSO~Lancaatar~ir. NE-$uilag'---,-Salem',O~°v'~7'j0~ , <br /> <br /> MEO~NI~P~APPLI~TION ~ID~AL ( )~OMMERCIAL ( )GAS (~CIRIC <br /> <br />~. ~ATmn o~ t~m~T~O~ ...... ,, ~5pEC~ 3N <br /> Fo~ ~ up to 100,0~ ~ x $12.00 <br /> SimAd~s: ~ / ~Fumaca x $12.00 <br /> <br /> ~el ~H ' ~ ~ F~ (up to 100,000 B~) x $12.~ = <br /> <br /> C~S~om: ~~ ~ ~W~H~ x $15.00 =$ <br /> O~ ~g ~ x ~15.00 <br /> <br /> ~rM~H~ x $12.00 ~ <br /> E~ ~lsr x $ 9.00 - <br />2~ ~RO~~TION ( / fi not~d~m~t x $ 6.00 = <br /> <br />Mailing Address: <br />City: State: Zip: <br />?hon¢~ Fax: <br /> <br /> the PROPF. RTF OM~filER and owm re~de im or will ~de in ~e <br /> <br />offend for ~ befo~ or u~n comple~om Ill ~ ~bcon~to~. I will <br /> <br />O~e/Ihvo Family Dwelling Fee <br />Dw,.m,~. Peemit Labels <br />(For New Dwellings Only) <br />Othee (as required by the Building Oflicia0 <br /> <br />$I5.00 = <br />$6.00-- <br />$60.00 = <br /> <br />B. Emer.30%oflina AL for Plan Review <br />C. lnves~i~ion Fee, ffmqu~ <br /> <br />~ Addle[ p~ ~v~w, ~2.5~ho~, ( mln~um <br />F. I~n f~ which no faa is s~Ri~I~ ~d~ ~2.5~r. <br /> (m~ one hour) <br /> <br />H. ~iamic F~a (.01% x Al) <br /> TOTAL <br /> ~OUNT <br /> DUE <br /> S <br /> <br />~. FEES <br />Al. B.4~E F~ A~t~t~d on ALL APPLICATIONS: <br />~ En~To~l F~ ~ ~don ~4 <br /> <br />~ A~ ~ SG~h~.05% x A [ +A2) <br /> <br /> <br />