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FOR CIT~ YALIDATION <br /> <br />COMMUNITY DEVELOPMENT CENTER tI~IT~ ~d~ <br /> 285_ Chut~~ ~t..,.I~.. · R~m 132 <br /> <br /> - <br /> ~ hr. l,speetinn Llue 373~427 <br /> O~ce: Phone 58~5147 8:00nm - 4:30pm <br /> F~: 58~794S <br /> <br /> pAL PERMIT APPLICATION <br /> lete all Sections, I through $ <br /> <br />' 1. LOCK'rloN. OF INSTALLATION' <br /> <br />Sob Address ~,~1~'~ I~ <br />cit;, <br />Property Ow~r "~ ~"~ I Phone~'~-"~- <br /> <br />IP I iR.MITS ARE NON-TRANSFERABLE AND I~{FIKE IP WORK IS NOT ] <br />STARTlaO VtqT}HN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPEI~IDED FOR 180 DAYS. <br /> <br /> 2A. CO]NTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Pmt~a~ Owner (,o/et s~ prit~) <br /> <br />M~iling Addlzsa Phone <br />City/State/Zip <br />Owner's Signature: <br />Ageat's Signatu~: <br /> <br />4. FEE SCHEDULE (Complet~ and eflte~ total in Al b~low) <br /> <br /> RESIDENTIAL I--I COMMERCIAL ~ <br /> USE OF STRUCTURE: <br /> NEW,li~ ALTERATION U~ ADDITION r~ RELOCATION <br /> GAS~l[ or ELECTRIC G <br /> No. X Fee ,~ Sum <br />BASE FEE $10.00 <br /> <br />FORCED AIR FURNACE <br />up to 100,000 BTU [ $ 6,00 <br />over 100,000 BTU $ 7.00 <br /> <br />FloorFumace $ 6.00 -- <br />Suspended Heater $ 6,00 <br />Wall Heater $ 6.00 <br />Floor Mounted Heater $ 6,00 -- <br /> <br />HEAT pUMP <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />AIR CONDITIONER <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />EvaporativeCooler <br /> <br />$ 6,50 <br />$11,00 -- <br /> <br />$ 6,50 -- <br />$11,00 -- <br /> <br />$4.50 <br />$4.50 <br />$4.50 -- <br />$4.50 <br /> <br />$ 3,00 -- <br />$ 3.00 <br />$ 7.50 <br />$7.50 "t--,~ <br />$30.00 -- <br /> <br />$ 7.50 <br />$7.50 -- <br />$7.50 <br />$7.5O <br /> <br />GAS PIPING SYSTEM <br /> 1-4 outlets (per outlet) <br /> 4 and up outlets (per outlet) <br /> <br />Appliance Vents not included in <br />an appliance p~rmit <br /> <br />OTHER (~s requited by Builch't~ Og~ciaD <br /> <br />DWELLING pERMIT LABEL # of Labola <br /> <br />$ 2,00 <br />$ .50 -- <br /> <br />$ 3.00 __ <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 SB and submit two ~2) sets of plans and <br />specifications with this application. <br /> <br />MC 15-41 <br />REV 8~6 <br /> <br />5. FEES <br /> A 1. Enter total of fees fiom Se~. ~4 <br /> A2. Add 595 surcharg~ (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter 25% of line A1 for Plan Review <br /> (Al + ,25), if required <br /> C. Investigation Fee (if requi~l) <br /> D. Reinspecfion Fe~ ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br /> <br />