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FOR CITY USE ONLY <br />Received By: Date: -- <br />Zoning By; City: <br />i ~,cceipt '4: Amount: $ <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete a~I Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Parcel ID: <br /> <br />Cr~s SirecUDiv~tions: <br /> <br />WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INFORMATION -- PLEASE INDICATE <br />WTdO IS DOING THE WORK <br /> <br />Con.actors Board <br />Regisiralion No.: ~ <br />Ccm~ractor's Sigua <br /> <br /> FOR 0 ~N~ R INSTALLATION <br /> <br />Property Ownec (plecae pdnO <br />Mailing Adckcss: <br />City: State: Zip: <br />Phone: Fax: <br /> <br />ContracWrs Board, I will immediately notify Marion County of the <br /> <br /> Owner's Signature: <br /> <br />I Ageat's Signature: <br /> <br />3. PLAN REVIEW SECHON <br /> <br />Marion County d~es not require a plan review. We will provide plan <br />review service if you complete S~ction 5B and submit two (2) sets of <br />p aris and spec fications with this application. <br /> <br />MC 1541 Rev 9/98 <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br />3150 Lancaster Dr. NE - Suite C, Salem, Oregon ! <br /> 8:00am - 4:30pm <br /> 24 HR Inspection Line 373-~A~ __ FA~_._5~-7948 ,JUL 0 9 1999 <br /> 4. FEE SCHEDULE (com'pl~e a~ter to~al in Al) MAI IO <br /> <br /> ) NEW ( ) ADDITION ( ) ALTERATION <br /> <br />) RELOCATION ( ) REPLACEMENT <br /> <br />OTY <br /> <br />5. FEES - - <br />BASE FEE Assessed on ALL APPLICATIONS: $ 25.00 <br />Al. Enter total of fees fr~m Sec. g4 $ ~ <br />A2. Add State Sm'charge (.05% x Al + Base F~) $ ~ <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />