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MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br /> <br />IF OR CITY VALIDATION [ <br /> Reoeived by: [ <br /> Date: [ <br /> <br /> Please complete all Sections, 1 through 5 I _ ~ <br /> APR 2 0 lqq <br /> <br />1. LOCATION OF II~ISTALLATION <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />liB. FOR OWHBR IlqSTALLATIONS <br /> <br /> Properly Owner (pIeasc print) <br /> <br />, <br /> <br /> 3. PLANREVIEW SECTION <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 of plans and <br />specifications with this application. <br /> <br />PERMIT NO: <br /> <br /> .. <br /> <br />,ad by: <br /> <br />4. FEE SCHBDULE (Complete and enter total in Al below) <br /> <br /> RESIDENTIAL ~ COMMERCIAL ~] <br /> USE O,F STRUCTURB: <br /> NEW~5-ALTERATION O ADDITION n RF~LOCATION <br /> <br /> GAS 0 or ELECTRIC <br />rlOK VEE <br /> PORCED AIR FURNACE <br /> up to 100,000 BTU <br /> over 100,000 BTU <br /> <br /> FIo~r Furnace <br /> Suspended Healer <br /> Wall Heater <br /> Floor Mountetl Healer <br /> <br />No. X Fee = Sum <br /> Sl0.00 <br /> <br />HRAT PUMP <br /> under ] Ton <br /> 3 Ton and up <br /> <br />AIR CO/q)ITIONBR <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />Evaporativ¢Cooler <br />Commercial Exhaust Sys~:m <br />Commercial Hood and Exhat~t <br />Domestic Range Hocxl <br />Domestic Exhaust Fans <br /> and Dryer Vents <br />Fire Damper <br />Wood Stove/Fireplace <br />Furnace Duels ( A lt~ra~inn/~xt ¢nsio n) <br /> <br />GAS PIPING sYErEM <br /> 14 outlets (per ouflel) <br /> 4 and up outlets (per outlet) <br /> <br />Appliance Yenls not included in <br />an appliance permit <br /> <br />OTHER (as ~equired by Buildiqg OItfciM) <br /> <br />DWELLIHG PERMrr LABEL #of Labels <br /> <br />$ 6.OO <br />$ 7.OO <br /> <br />$ 6.00 <br />$ 6.00 <br />$ 6.ill) <br />$ 6.0O <br /> <br />s ~.~o b,5o <br />$11.OO <br /> <br />$ 6.50 <br />$11.00 <br /> <br />$4.50 <br />$4.50 <br />$4.50 <br />$4.50 <br /> <br />$3.0O <br />$ 3.00 <br />$7.50 <br />$7.5O <br />$30.0O <br /> <br />$7.50 <br />$ 7.5O <br />$ 7.50 <br />$7.50 <br /> <br />$ 2.00 <br />$ .50 <br /> <br />$ 3.00 <br /> <br />N/C <br /> <br />5. FEES <br /> A 1. Enter total of fccs from S~./$4 <br /> A2. Add5% surcharge (.05 x Al) <br /> <br /> B. Enter 25% of line A 1 for Plan Review <br /> (Al + .25), if requirud <br /> C. Investigation Fce (ifr~quired) <br /> D. Rci~spection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br /> <br />