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...... , .......................... ~ ~ ~/~ MARION COUNTY BUILDIING INSPECTION <br /> FOR CI~Y USEONLY 11) } } ~/'z'~ ~ [~Il [ COMMUNITY DEVELOPMENT CENTER <br /> Received By' Date.._~.~,/r~ (~]~'~[~.~3150 La.caster Dr NE- Suite C, Salem, Oregon 97305 <br />~?--' n ,' cw'--~---~,~d.~ij[ [~/c'~j.~.. '8:00am-4:30pm <br /> ~ # Amoun! ~ ! ~ )~spectlOn. Line 373-4427 FAX 588- 948 <br /> <br /> MECHANICALPERMITAPPLICATi~/~14~/0fi/ ~ ' ~DE.'CrlAL ( )COM~'RClAL ( )CO~.S ( )ELEC'rPdC <br /> <br /> L ~ON OF ~ST~ON C~'~[O~ <br /> "~1 ~ ' ~ (~dud~ du~ / ~) <br /> <br />Cross Str~dDir~tions: <br /> <br /> ,Projcct Description:~.~/ I ~T h ?* <br />]PERMIT~ A~E NON-TRANSFEI~t2LE AND EXPIRE IF WORK <br /> 15 NOT STARTED WITIIIN 180 DAIq$ OF ISSUANCE OR IF <br /> wotac ts svsrE~Eo FO~t zso <br /> <br />2n. com~Acron oatomanTton -- PL~nSE <br />WHO IS DOING THE WORK <br /> <br /> Ci~: S~: ~: <br /> <br />I am the PROPERTY OWNER and own, reside in, or will reside in <br /> <br />*tructure is sold or offered for sale b~for¢ or upon completion, lf l <br />hire subcontractors, I will him only subcontractors registered with <br />the Construction Cantracwt$ Bonr~ If I clmnge my mind and do <br />C~ntractors Board, I v/itl immediately notify Marion County of the <br /> <br />Owner's Signature: <br />Agent's Signature: <br /> <br />3, PLAN REVIEW SECTION <br /> Marion C~ty does not r~quim a pl~ ~vicw. W* will ~ovlde plan <br /> ~vlcw ~ if ~ compl~ S~fi~ 5B and ~b~t two (2) ~ of <br /> pl~s ~d ~ffi~s wi~ ~is appliration. <br /> <br />MC 15~1 ~v <br /> <br />$15.00=$__ <br />$15.00=$__ <br />S15.00 = $ -- <br /> <br />Gas Furnace (over 100.000 BTU) <br />Gas Fireplace / <br /> <br />Ga~ Log Ligh'~r <br />Oas <br /> <br />Suspcnd~dI4ea~r -- x $12.00--$ . <br /> <br />Und~r3Ton ~ X $12.00=$__ <br />3 Ton a~d More __ x $22.00 = $ <br /> <br />3TonandM~r~ __ x $22.~0=$__ <br />Evalx~ative Cooler -- x <br /> <br />Dome~c Range Hood (includes ducts) __ x $9,00 ~ $ -- <br />Dome~c £xhatm Fa~ __ x $6.00 = $ <br />Dcaggic Dryer V~ts ~ x $6.00 <br /> <br />not i~cled~d in an appliance permit __ x $6.00 = $ -- <br /> <br />g~re Dampgr __ x $&O0 = S -- <br />One,TwoFsmUyO~,lin~Fze:SquareFcec __ x $ .04=$~ <br /> <br />Othcr (as required by the Building Official) $ <br /> <br />BASE FF~ Assessed on ~ APPLICATIONS: $ ~.~0 <br /> A 1. Eat~x total of f~s from S~c. 144 $ C)~.~O~ <br /> <br /> ($62.50/hr, rainimam two hours) <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />