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*i .................................... ] /~) ~'~:~ ~/I~RION COUNTY BUILDING INSPECTION ,FORCI'I'YUS~L~~') t'~.~"~ ]~/~~OMMUN~DEV~OPM~CE~ ~ ~i~ · ~ounC $ ~ ~ 24 ~~ 373~27 F~ ~88-7~8 ...................................... _ I ~mCAL PE~T AP~ICA~ON I ~"~/0~ - ~~ ' ~CO~ , ,OAS , ~ E~C I I ~ ,.. . ~ ~W ( ) ~D~ON ( ) ~TION 1. L~A~ON OF ~ST~LA~ON I/0~ Zip: PE~ITS ~ NON-T~N$FE~ AND EXPI~ IF WORK NOT STARED W~HIN 180 DAYS OF ISSU~EE OR IF WO~ IS SUSPEND~ FOR 180 DAYS. 2A. CO~OR ~ON ~ ~ASE ~ICA~ 2B. FOR O~R ~ST~ON ~t~ ~ ~M or o~e~d ~r ~ale befom or up~ co~le~o~ Ill t~ Con~t~c~ Con--tom B~ If I c~ge my mi~ ~ ~ 3. PLAN REV1EW SECTION Marion County does not reqlfirc a plan review. We will provide plan review service if you complet~ Section SB and submit two (2) sets of plans and specifications with th s application. MC 1541 Rev 9D8 ~ (includes ducts I vents) Forced Air up to 100,000 BTU x $12.00 = $__ Fo~d Air over 100,000 BTU -- x $15.00 = $ -- F~oo~Furaace __ x $12.00=$ Ducts (Alterations/Extension) -- x $15.00 = $ -- Oas pumace (up to l00,000 BTU) -- x $12.00=$__ Gaz~urnacc(ovcrl00.0OOBTU) __ x $15.00=$ Gas Fireplace / inser~ -- x $15.00 = $ -- Oa~ Water Heater __ x $15.00 = $ -- Gas Log Lighter __ x $15.00 = $ .-- GasBafoeque -- x $15.00=$__ Oas Piping Each omlet up to 4 oudets __ x $4.00=$ Each additional outlet over 4 outlets -- x $1.00 = $ He~lers Suspended Heater __ x $12.00 = $ Wall Heater x $12.00 = $ Floor Mounted Heater __ x $12.00=$__ Under 3 Ton -- x $12.00 = $- 3TooandMom -- x $22.00--$__ Undo' 3 Ton x $15.(30 = $ -- 3 Ton and More x $22,00 = $ -- Evaporative Cooler __ x $9.00 = $ -- Coral Exhaust System -- x $9.00 = $ -- Coral Hood & Exhaust __ x $9,00 = $ -- Domestic Range Hood (includes ducts) __ x $9.00 = $ Domestic Exhaust Fans __ x $6.00 = $ -- Domestic D~er V~u~ __ x $6.00 -- $__ Appliance Vents iv, stalled and not included in an appliance permit __ x $6,00 = $ Woodstove / Fireplace [ x $15.00 = $ . _ Fire Damper __ x $6.00 = $__ Coral / Industrial Ineine~ato~ -- x $60.00 = $ -- BASE FEE Assessed os ALL APPLICATIONS: Al. Enter total of fees from,,,~See. ~ A2. A~ S~te Sum~ x A1 + B~ ~) B. ~t~ 30% ~ ~ A1 f~ ~ ~cw C. Inv~figafion ~ (if ~) D. RcM~ F~ ($~0.~) ~nimm onc-~f ho~) E In~fi~ ~ w~ no ~ ~ s~ly in~,~ ~. ~s~on Ou~ N~I Busin~ ($62.~0~. ~um two bm) H. S~i~ F~ (.01% x Al)) TOTAL AM~DUE