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FOR CITY VALIDATIONI <br />Received By: I <br />Date: I <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Lancaster Dr, NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Impec~n Une 373.4427 <br />Office: phone S88-$147 8:~ - 4:30pm <br />FAX ~88-7948 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> oWNI~R s <br /> <br /> CROSS STEEET/ <br /> DIRF-.C'~OHS <br /> <br />PERM]TS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN Iii) DAYS OF ISSUANCE OR ]~ <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />3. PIAd~ REVIEW SECTION <br /> <br /> Marion County does not require a plan review. <br /> We will provide plan review service if you complete <br /> Sect[on 5B and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />4. ~ S~UL~ (Complete and entex total in Al below) <br />RESIDENTIAL t'l COMMERCIAL t'l USE: <br />NEW t'l ~TION ~ AVVmO~ <br /> <br />BAS~, Ir~E ASSESSED ON ALL APPLICA'noNs <br /> <br />FORCED AIR UP TO 100,0{30 BTU '~(.-~ x {6.00 =$ __ <br />FORCED AIR OVER 100,0~0 BTU x S7.00 = $ __ <br /> <br />Al. Enter teud of fees fi~m Sec, #4 $ <br />A2; Add 5% su~chmge (.05 x Al) $ <br /> Subto~ $ <br /> <br />B, l~ter 25~ of line Al for Pl~ti Review <br /> (Al + .25), if requital <br />C, lnvesfiga*inn Fee (if required) <br />D. Reinsl~ecfion Fee ($25,00) <br /> <br />Receipt No. <br /> <br />TOTAL AMOUNT DUE <br /> <br />MC 15.41 7/~7 <br /> <br /> <br />