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MARI--Ofi~Y BUILDING INSPECTION <br /> e=~ f~ ~'~ ~~ DEVELOPMENT CENTER PERMIT NO - <br /> R ch St NE · Room 132 <br /> <br />a~= ~y: !_at.t" I ~ 7' lg97.. ~ ~7~.__ Date: <br /> <br /> ~IARION COUNTY <br /> MECHANICAL PERMI~U~,~I~PI~I{~ <br /> Please complete all Sections, I through $1 <br /> <br /> l, LOCATION OF [N~'rALLATION <br /> <br />I]PERMITS ARE NON-~Lt~NSFER~EI.~ AND ~ m WO~ 1S NOT <br /> <br /> wo~ is sos~ ~oR i ~ D~Ys. <br /> <br /> ~. FOE O~ <br /> <br />~op~ty Owner (pleese pt'iA) <br /> <br />Mailing Addr~a <br /> <br />Cia/State/Zip <br /> <br />Owner's $ignatu~: <br /> <br />Agent's Signature: <br /> <br />FAX: 5~8-7948 <br /> <br />4. ~q~]~ $CHI~DLI~F[ (Complete and ~nter ~ ~ A1 below) <br /> ~IDE~I~ ~ ~O~M~RCI~ ~ <br />USE OF ~RUCT~E: ' '1~ <br />~ ~ ~TION ~ ~D~~ATION <br /> GAS Q ~ ~IC~ ~ <br /> No. X P~ <br />B~E ~E <br /> <br />FORCED ~ ~ACE <br />up ~ i~,~ B~ $ 6.~ <br />over 1~ O~ B~ ...... $ 7~ <br /> <br />R~r F~ac~ $ 6,~ <br />S~n&d Heater $ 6.~ <br />W~ Hoter $ 6.~ <br />~ M~n~ H~ter $ 6.~ <br /> <br />ImAT pUMP <br /> ~der 3 Ton <br /> 3 Ton and up <br /> <br />AIR COHDITIOI~R <br /> un~r 3 Ton <br /> 3 Ton and up <br /> <br />Eva~rat~l~ <br /> <br /> 6.50 <br />$11.00 <br /> <br />$6,~ <br />SILO0 <br /> <br />$ 4.50 <br />$4.5O <br />$4.5O <br />$4,5O <br /> <br />$ 3.00 <br />$ 3,OO <br />$7,50 <br />$ 7.50 <br />$30.00 <br /> <br /> Other <br /> <br />GAS PIPING SYSTEM <br /> 1~4 outleta (per outlet) <br /> <br />OTHER (as tvquiced by Buil~ 0~1) <br /> <br />D~ING PE~ L~ flor ~ <br /> <br />$ 7,5O <br />$7,50 <br /> <br />$7.5O <br /> <br />$ 2.00 <br />$ .5O <br /> <br />$ 3.00 <br /> <br />N/C <br /> <br />3. PLANRBVIBW SBCTION <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 ofphns and <br />specifications with this application. <br /> <br />MC 1541 <br />REV 8/g6 <br /> <br />AL Enter totalof fees from Sec, ~4 <br />A2. Add 5% ,urcharge (.05 x Al) <br /> <br />Subtotal <br /> <br />B, Enter 25% of lineAl for Plan Review <br /> (Al + .25). if r~ui~d <br />C. Inv~et/gation F~e (ifrequh~d) <br />D, Reimpecfion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE. <br />R~ceipt No. <br /> <br /> <br />