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FOR CITY USE ONLY <br />Recein"ed By: .Date: <br />Zoning By: City: <br />ReceLpt ~: Amount: $ <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Pleas~ complete all Sections, 1 through 5 <br /> <br />1. LOCMHON OF INSTALLATION <br /> <br /> Phone: <br /> <br />PE~ITS ~ NON. T~NSFE~B~ AND EXPI~ IF WORK <br />15 NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WO~ IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CO~R ~TION ~ PLEASE ~ICA~ <br /> <br /> ~afion No.: ; <br /> Con~t~'s S~natu~: <br /> <br /> I am t~ PROPER~ O~E~ and ow~ ~s~ ~, or will m~e in <br /> <br /> st~tu~ is soM or offered for xale before or upon completio~ I~ I <br /> ~ C~t~c~on Con~r~ Boa~ lfl c~ge my mi~ ~ do <br /> Contmctor~ B~ <br /> <br />1541 gev 9/98 <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />3150 Lancaster Dr. NE - Suite C, Salem, Oregon 97305 <br />8:00am - 4:30pm <br />24 HR Inspection Line 3734427 FAX 588-7948 <br /> <br />4. FEE SCHEDULE, (complete ami enter total in Al) <br /> <br />) NEW ( ) ADDITION ( ) ALTERATION <br />) RELOCATION (~) R~PLACEMENT <br /> <br />( ) E~ECTP, IC <br /> <br />~ (i~clud~ ducts / veers) <br />~orced Air up to 100,000 BTU L x $12.00=$ <br /> <br />~eat I'um~ <br /> <br />OneffwoFamRyD~sell~gFee:Sqoa~eF~ct: -- x $ .04--$__ <br /> <br />NIC <br /> <br />BASE FEE Assessed on ALL APPLICATIONS: $ Al. Enter total of fees from Sec. #4 <br /> <br /> A2. Add State Su~harg~ (.05% x Al + Base <br /> <br />C. Investigation Fee (if required) <br />D. Re~s~oa F~ ($50.~) <br /> <br /> ~nim~ one-~lf ho~) <br />E Ins~on f~ w~ch no f~ ~ s~ly indi~/ <br /> (~2~, ~nimum ~e ho~) <br /> <br /> ($62.50~, m~ two ~) <br />H. Seismic F~ (,01% x Al)) <br /> <br />TOTAL AMOUNT DUE <br /> <br />$__ <br />$__ <br /> <br />$__ <br />$__ <br />$__ <br />$__ <br /> <br /> <br />