Laserfiche WebLink
FOR CITYa/y.~I_.~. ~T~N <br />Received <br />Date:_~..~._ <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />COMMUNITY DEVELOPMENT CENTER ~JJl C,-~ ~:}c/& .,~ <br />2~ Chu~St NE. R~m 132 <br /> <br /> ~v~ Ine~M: <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WOR~ 15 NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Mailing Addr~s <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Property Owner (pl~s~print) <br /> <br />Mailing Addrgss { <br />City/State~ip <br /> <br />Owner's Sismatur~: <br /> <br />3. PLAN REVIEW 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 15-34 12/94 <br /> <br />I000 sq. fl. or le~s <br />Each additional 5(]0 ~q. ft. <br /> <br />Limited Energy $20.00 1 <br />~eh Manufactured H~ne or Modular <br />D~vdling Service or Fe~der $40,00 2 <br /> <br />B. 8~rvie~ ~ Fa~d~s (Do~g not inqud~ ~eh eir~uim, ~eo ~gfion D) <br /> <br /> N~, ~t~at~ ~ E~en~on P~ Pa~l <br /> . <br /> <br />b} Tho f~ for branch eir~uit~ without <br /> ~ha~e of s~wlce o~ f~er f~ <br />F~t b~ch ci~uit <br />~ a~fionnl b~oh c~t <br /> <br />~5.00 <br />$ 2.00 <br /> <br />5' l~E8 Al. Enter total of t'~e~ from Se~. #4 <br /> A2. Add 5% sumhargo 605 x Al) <br /> <br />Subtotal <br /> <br />B, Enter 25% of line Al for Plan Review <br />(See. 3), if mquiv0d $.__ <br />C. lnvemtigafion 1%0 (1 f r~quirod) $.__ <br />D. Reimpeetion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE $.__ <br />I~ccipt No, <br /> <br /> <br />