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03/24/98 TUF 09:§2 FAX ! 503 588 7948 <br /> <br />MARION BLDG INSP <br /> <br />OO3 <br /> <br />FOR CITY VALIDATIONI <br />Received By: <br /> <br />Dale: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Lanca~te~ Dr. N~ - 5uile C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Inspection Line 373..4427 <br />O~ce: phoneSBS-5147 S:0Onm -4:30pm <br />FAX 588.7~48 <br /> <br /> MECHANICAL PERMIT APPLICATION { <br /> P/ease complete all Sections, I through 5 <br /> <br /> LOCATION OF INSTALLATION <br />-~,r~ ?~.o ~./?/ <br />T~^~°~"°.I { ,I } I J~l I I 1- <br /> <br />~0~ ~ <br />~ I"1 I I-I I I I-I I I I <br />CR~5 S~/ <br />D~5 <br /> <br />ARE NON-TRANSFERABLE AND E~'IRB IF WORK 15 NOT [ <br />STARTED ~ 180 DAYS OF ISSUANCE OR IF <br /> WORK 18 SUSPENDED FOR lg0 DAYS. <br /> <br />~2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B, FOR OWNER INSTALLATIONS <br /> <br /> Mailing Address <br /> <br />City, St~e, Zip <br /> <br />Owner's Slgflam~ <br /> <br />Agent's $lgoatur~ <br /> <br />3. PLAN REVIJEW SECTION <br />]Mado.~ CounJ.y does not require a plan review. <br /> We will provide plan review service il' you complete <br /> Section 5B and submit two (2) .sets of plans and <br /> specifications with this application. <br /> <br />PERMIT NO: <br /> <br />Date:. <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete s~d .nlcr to~l in Al .below) <br />Rgsm~I~TIAL ~] COMMERCIAL ~ USE.__- Z <br />N~V'{~ ~L'~P~A'nON O ^vDmoH O R]iLOCATION {-{ P. EPLAC{~ <br /> o~s O ~scr, uc O <br />nA,,SE FEI/: A, SSESS~D ON ALL, APPLICATIO.,NS. $10.00 <br /> orr <br /> <br />x ~6.00 -$__ <br />x $?.00 =$ -- <br />x $7.50 = $ <br />x $7.~0 =$ <br />x S7,~0 <br /> <br />x $11,00 S <br /> <br /> TOTAL AMOUNT DUE <br />R~eipt No .... <br /> <br />$ <br />$ <br />S <br /> <br /> <br />