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FOR CITY VAI Jr~ATIONI <br />R~eived by: <br />Date: <br /> <br />COMMUNITy DEVELOPMI~T <br /> 285 Church St NE · Room 1:t2 <br /> S~lem, OR 97301 <br /> <br /> 24 hr. Insp~flon Line 3734427 <br />Office: Phone 58~-5147 8:00am - 4:30pm <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete ~11 Sections, I through <br /> <br />1. LOCATION OF I/~WALLATION <br /> <br />"Ps~,,a-rs ^~ NOr~-~NSm.~US AND SXmS ~ WO~ ~s N~ <br /> ST~ ~ 1 ~ DAYS OD I~UAN~ OR ~ <br /> WO~ IS SUS~ ~R 1 ~ DAYS. <br /> <br />~ CO~CTOR ~LA~ON O~Y <br /> <br />Mai[i~ Add~ ~ <br /> <br />Electriei~ <br /> <br />8upervisor', Lieen~ No. <br /> <br />211. FOR OWNllR IHSTALLATIONS <br /> <br />Owner (plea~e prlnt) <br /> <br />Mailing Addres~ I l~ne <br /> <br />· L~ty/~tate~Z~ <br /> <br />Ovn~r's Slgnatut~: <br /> <br />3. PLAHREVIEW SECTION <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 />MC 15-341/96 <br /> <br />Date: <br /> <br />4. F]~l~ SCHEDUi-,~, (Cmnpletoand~nter totalinAl bel/~0~/ <br /> <br /> ~1 amps to ~ ~ $t~.~ 2 <br /> ~ amps to 1~0 ~ $1~ ~ 2 <br /> 2 <br /> <br /> 2~ ~or le~ S35~ 2 <br /> <br /> b) ~e fee f~ ~ane~ d~ui~ ~ <br /> <br /> ~t brach e~t I S35.~ ~'~ <br /> ~eh ad~fio~l b~eh e~t ~ $ 2.00 ~ <br /> <br /> ~ ai~ or ~tl~e li~g -- ~ 2 <br /> ~er lhe allowab~ ~ ~y ~ ~ <br /> <br /> Aum~ ~elling El~ie~ F~ --~q. ~. x $,068. <br /> <br /> <br />