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FOR CITY VALIDATION <br />Received by:, <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Chumh St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />24 Hr Insp~tion Line: 588-7904 <br />Office: 5;88-5147 8:00 a.m. - 4:30 p.m. <br />FAX: 588:7948 <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> P/ease complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Dir~ti~m <br /> <br />Dtk'.ctlption <br /> <br />2A. CONTRACTOR IN$TALLATION ONLY <br /> <br />Mailing Address . ,~, _~_._~-~,~)~ <br />Pwpcrty Owm:r I Phone <br /> <br />,.,$.u_p~2!!or', License No...~.,,.~ 7 ~2 ,,,l, I~o~ <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Properly Owner (please priaO <br /> <br />Mailing Add~a~s I Phone <br />CitylStateggip <br /> <br />3. PLAN REVIEW SI~CTION <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 />M~ 15-34 12.d;;4 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Comple4v and ~ntex total in Al below) <br />A, Residential Per Unit Number oflnap¢ction~ p~ permit allow~d~ <br /> <br /> ~hase of semite of feeder fee [~ <br /> <br /> (~ ceqaicod by ~ildi~ OlSciaO <br /> <br />5, FEES <br /> A I, Enter rolm of fees fro~tl Sec, #4 <br /> A2, Add 5% surcharge (,05 x A 1 ) <br /> Subtotal $.__ <br /> <br /> B, Enter 25% of line A l for Plan R~vi~w <br /> <br /> C, hwestigalion Fee (if~quired) $ <br /> D. Reinapection Fee ($25.~) $.~ <br /> <br /> <br />