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Received <br /> <br />Date'. <br /> <br />MARION cOUNT~:B~ILDING INSPECTION <br />~nator Bldg. No, 225 <br />220 High Stm~t NE <br /> <br />MECHANICAL PERMIT APPL CATION <br /> <br />Owner: ~ ' Address: <br />Situs Address; -- Site NO,: Cross Street: <br /> Az. (,,,, Clo e <br />Mechanical Installer: Phone; Address; <br />Home B~ilder'~ Registration No,; .......... <br /> <br />Rasld~n~ ~ Comm~miah ........ Use~fBuildlng: ~' ~ <br />~-/t~ on: ~ Relocation: ~ OccuPancyChange: D ..... <br /> <br />~_.~/~~ /~'~zz~'~ FEE AMOUNT <br />6.00 <br />6-00 <br />~ ~' ~ ~.oo ',' ',' <br />g. O0 <br />4.50 <br />7.50 <br />4.50 <br />{,50 <br /> <br /> Domestic Range Hoods 4.50 <br /> Domestic Exhaust Fan~ & ~r vents 3.00 <br /> Domestic Wood Stove ~ 7.50 ~ ~O <br /> <br />Commemlal.or Ind-~-triel Incinerato~ <br />Fire Damper <br />Gas Water Heater <br />Gas Connection w/o Appliance 1-4 each) <br />over 4- $8.00 plus aa, addnl. <br />Appliance or accessory to any heating or <br /> <br /> Comfort cooling system not coveted <br />Othe[ (as per Mechanical Code): <br />On-Site Technical Review <br /> (Apply at Marion Co. only) <br />Reinspec{ioe Fee <br /> <br /> FEE <br />STATE SURCHARGE <br />PI~,N REVIEW FEE <br />INVESTIGATION FEE <br />FLEET SURCHARGE: <br />CITY FEE <br /> TOTAL <br /> <br />Please return COMPLETE APPLICATION with the indicated fee, <br /> <br />) I am performing work on a property I own or o~cuPy. <br />) lamareglsteredbuilderOR( )theauthorizedrepresentatlveof SIGNATUREOFAPPLICA <br /> <br /> The work will be sade_ LEted I~ a regi~m~J;~uilder. ~ ~.~, // <br /> <br />Rev, ,3/87 <br /> <br /> <br />