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FOR CITY VALIDATION[ <br />Rzoeived by:.... <br /> <br />MARION COU1WrY BUILDING INSPECTION <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. lasp~tion Line 373-4427 <br />Office: Phone fl88-5147 8:00am - 4:30pm <br /> <br />~L PERMIT APPL~ <br />Pi~o all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> PERhfiTS ARE NON-TRANSFERABlE AND EXIqRE IF WORK 15 NOT <br /> STARTED WITHIN 1~0 DAYS OF ISSUANC~ OR IF <br /> WORK lS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Eleotr~al Ce~tractor I Phone <br /> <br />bhapm~hsor's Lic~rss No. <br /> <br /> FOR OWNBR INSTALLATIONS <br /> <br /> 3. PLANREVIIIW SRCTION <br /> <br /> I Mario~ Coullty does not require a pl.a~ review. <br />| We w|tl prOvide plan review service if you complete <br />i t $ec~. ~on 5B and submit two (2) sets of plebs trod <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br /> Nimlber of~ ~ ~t ~ ~ <br />R~i~ <br /> Unit <br />~Ia~M: ~ ~t(~h) S~ I <br /> ~ ~s S8~.~ 4 <br /> <br />~t~, ~ati~ ~ ~fi~ ~ <br /> or 1~ ~ $~.~ 2 <br />~1 ~ ~ ~ am~ $I~.~ . 2 <br /> <br /> ~pa or vol~ ~.~ 2 <br /> only ~ 2 <br /> <br />C. Temporary 8er~iee~/~d~m <br />Inataliatlm~, Aim'orion. ~ <br />~ ~ or 1~ $35.~ <br /> <br /> ~1 ~to~ $~.~ <br /> <br /> a) ~o fee f~ b~h o~ ~ <br /> ~ ~ c~uit $ 2.~ <br /> <br /> b) Th~ feo for branch oiz=eiia without <br /> <br /> Fire brach cL,~uit <br /> ~h ad~n~ b~h c~t <br /> <br />E. ~s (~v~ ~ F~ ~ l~ud~) <br /> ~ si~ or out~e li~ <br /> <br /> a~, ~r ~p~ <br /> <br /> Pa~k of 10 I~1~ O ~.~ ~oh <br /> (~ d o~y ~ el~o$ I <br />H. ~ <br /> (~ ~d by ~il~ ~e~l) <br /> <br />$ 2~0 <br /> <br />$35.O0 <br /> <br />$50.00 <br /> <br /> :;.fl. x $.0c~ = ,,, <br /># of Lal~ls. N~ <br /> <br />2 <br />2 <br />2 <br /> <br />5. FEES Al. En~r Iotalof fees from $m. #4 <br /> AZ AddS% surcha~ (.05 xAI) <br /> <br />B, Enter 25% oflh~ Al for PianRzvizw <br /> (S~. 3), ffmquimd <br />C. Investigation 1~ (if required) <br />D. R~inst~tion F~ (~3,00) <br /> <br /> TOTAL AMOUNT DIE <br /> P.~eipt No. <br /> <br />$ ,l'a <br /> <br /> <br />