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IReceived By: <br />IDate: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Inspection Line 373-4427 <br />Office: phone 588-5147 8:00am - 4:30pm <br />FAX 588-7948 <br /> <br />PERMIT NO: q~ "'O~.~ <br />Date: <br /> <br />Issued by: <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> T X^CC° N°. 16 I / 1 I21sI--IoIoIo <br /> <br /> I-I 1 1 I-I 1o1 1+ <br /> CROSS S~ET/ <br /> <br />PRO' CTOESC ON add:L <br /> <br />PERMITS ARE NON-TRANSFERABLE 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 />Mechanical Contractor <br />Mailing Address City <br /> <br />PHONE ~ ~ <br />FAX ~ ~ <br />CONTRACTORS BOARD <br />REGISTRATION NO. <br /> <br />CONTRACTOR'S SIGNATUKE <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Mailing Address <br /> <br /> City, State, Zip <br /> <br /> Agent's Si~at~e <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 (Complete and enter total in A1 below) <br />RESIDENTIAL [~ COMMERCIAL f'l USE: <br />NEW ~ ALTERATION [~ AODmON~[ RBL~O~ATION [] REPLACE <br /> ~^s ~ E~CmC ~ <br />BASE FEE ASSESSED ON ALL APPLICATIONS $10.00 <br /> <br />DOMESTIC EXHAUST PANS i x $3.00 <br />DOMESTIC DRYER VENTS ~ x $3,00 <br /> <br />s. ~ES <br />Al. Enter total of fees from Sec. fi4 <br />A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> B. Eater 25% of line A1 for Plan Review <br /> (Al + .25), if required <br /> C. Investigefion Fee (ff required) <br /> D. Reinspection Fee ($25.00) <br /> TOTAL AMOUNT DUE <br /> <br />Receipt No. <br /> <br />MC 15-41 7/97 <br /> <br /> <br />