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FOR CITY VALIDATION <br />Received by: <br />Da~e: <br /> <br />MARION COUNTY BUILDING INSPBCTION <br />COMMUNrFYDEVELOPMENT CENTER <br />285 Churcfi St NE · Room 132 <br /> Sslem, OR 9730 ! <br /> <br /> 24 hr. Insgeetlon Line 2173-4423' <br />O/flee: Phone 5855147 S:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all ,Sections, I through. <br /> <br /> L LOCATION ONIN~T~O~ ' ' <br /> <br />ISTAq <br /> <br /> PERMITS A RE MON-TRANSFER3,~LE AND F,.XPIF, E IF WORK IS NOT <br /> STARTED WrrHl/q 1~o DAYS OF ISSUANCI~, OR IF <br /> wOag Is susl,ra'ml~ FOE 180 DAYS. <br /> <br /> CONTRACTOR INSTALLATION ORLY <br />ue*ttiealc°~tnc~CHERRY CITY I l'h°ae3997609 <br /> <br />MailingA~ ELECTRIC POB 12668~, Salem <br /> <br />211. FOR OWNtlR INSTALLATIONS <br />Fairly Own~ (ple~te ptint) <br /> <br />CitylStat~/Zip <br /> <br />Ovn~r's Sitmamr~: <br /> <br /> PLAN RBVIEW 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 />PERMIT NO: <br /> <br />Date: <br /> <br />Issue~ by: <br /> <br />4. NEB SCH][]DUL~ (Cmnptete and eam'~l <br /> <br />~5,00 <br />$ 2.00 <br /> <br />FEES <br />A 1. Enter total of fee~ f~om Se~. #4 <br />A2, Add 5% surehar~ (.05 x Al) <br /> <br />MC 15-34 1/96 <br /> <br /> <br />