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I Reoeived by:.. <br />II)ate: <br /> <br /> Salem, OR 97301 -~,,~/.,~ j U~~~- <br /> tX Date: ................ <br /> 24 hr, Inspection Line 373-4427 ~ ~ IV]PdIIUN UUUI'41 1 <br /> Office: Phone $8~-5147 8:~0lm - 4:30pm \~'~ _ __ <br /> F~.. s~4a .')~ ~sue~ bIi~IIILDIHG INSPECTION <br />ELECTRIGAL PERMIT APPLICATION I <br />~hi~/so ¢omp/oto al~ ,~ct/oils, 10~rot/gh 5I 4. PEE $CI-ItIDUL~ (compleX.nd cn~er ~otali~ A] b~ow) <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PF~,IV~rs ARn NON-TRANSFERABLE AND l~g3~]R~ IF WORK IS NOT <br />STARTED W1THIN l~0 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPI~IDED FOR 180 DAYS. <br /> <br />CONTRACTOR INSTALLATION ONLY <br /> <br />:lB. FOR OWNER INSTALLATION~ <br /> <br />[Srop~riy Owner ~lc~ print) <br /> <br />Mailing Add~ <br /> <br />I Phone <br /> <br />Cityf~tate/Zip <br /> <br />Owner's Signature: <br /> <br /> 3. PLANRBVIEW SBCTION <br /> <br />:J Marion Coun~ do. not reqt~ire a Plan review. <br /> [ We will provide plan review ~ervice if you complete <br /> [ Secdon SB and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC 15-34 1,~6 <br /> <br /> Number of Inspections per Fennit allowed .-~ <br />A. <br /> Reeldantial <br /> Pe~ <br /> Unit <br /> · ~tvi~ Im~uded: [ter~ C<~ (z~h) Sum ! <br /> 1000 sq. ft. or le~ $85.00 4 <br /> <br />~r poma ~ <br />Limited Energy $'20.00 1 <br />Each Mamifactmzd Home or Modular <br /> D,~Uing Service or Feeder $40.~0 2 <br /> <br />$35.~ <br /> <br /> sq. ft. x $. 068 = __ <br /># of Labels N/C <br /> <br /> <br />