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MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> <br /> F! 285 Church St NE° Room 132 PERMIT NC) <br /> oR crrxW .LmA ON[ Salm OR 97301 <br /> <br />IELEcTRIcALPERMITAPPLIcAT~'O~N dEC~0/[ f0:~- <br /> Plea~e co~,plete all Sectlons, l through S J ' " '~. <br /> ~A~[0~ t~ ..... Nambcr of [n~l~cfiona <br /> <br /> LOCATION <br /> OF <br /> INSTALLATION <br /> ' ~ ~q. fl. m' teas <br /> <br />NON-TRANSI~iP. ABLE AND EXPIRE IF WO~ IS N~ ] <br /> DAYS OF ISSUAN~ OR · <br /> SUS~ F~ 1~ DAYS. <br /> <br />:lA. CONTRACTOR IHSTALLATION 0HL¥ <br /> <br />Elecuica{ Con?cm~ <br /> <br />Phoue~ <br /> <br />Pro~ert~ Owrmr <br /> <br />S~natu~e of Su~en, ism~ Electrician <br />Supervisor's License No. <br /> <br />Job No <br /> <br />phones <br /> <br />Marion Co~, d~s mt r~uim a pl~ ieview. <br />We will provide pl~ review semice if you co~ <br />S<fion 5B ~ submit ~o (2) <br />{ s~ificafi~s wi~ mis application. <br /> MC 15.34/~6 / lq/Y_ <br /> <br />$35.00 <br />$ ZOO <br /> <br />~ch pump or img~ion c ~le ~.~ ~ 2 <br /> <br />a~v¢, ~r l~pection $35.~ ~ <br />~k of I0 labeh ~ $5.~ ~ch $~.~ <br /> <br />~ r~uiced by ~ildt~,O~w;sO <br />A~ra ~e~ing Elec~ica~ F~ ~ sq ~ x $ 068 = <br /> <br />5. FEES <br /> A I. Erect to{al of fce~ Imm Sec. 84 <br /> A2. Add 5% surchacge (.05 x Al) <br /> <br />B. Enter 25% of line A I for Plan Review <br /> (Sec. 3), if~'quired <br /> <br /> · Invesligalk)n Fcc (ifn:quired) <br /> Reinapeclion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Reoeipl No. <br /> <br /> <br />