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FOR CITY VALIDATION[ <br />Received by: [ <br />D~te: [ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salenl, OR 97301 <br /> <br />PERMIT NO: <br /> <br /> 24 br. Inspection Line 373-4427 <br /> Office: Phone 588-5147 8:00am - 4:30pm <br /> F~.~s~.~4s Issued by: <br /> <br /> .......... ~- ...................... ~'-- - · t;q 4. Fl~E~CHl~}ULE(C~npleteandentertotatmAlbebw) <br /> t <br /> <br />I. LOCATION OF INSTAI.LA. TION ~,~,~'.,ql~ C( ~Servieelndudea: Ite. m~ C<~(~h) sum I <br /> <br />Io~ A~$vill~, I~ ,~/~.'- <br />I..~" Tr;Z~. _.+~. j ~'L ~t ~ -~ <br /> <br /> ~ ~ I~ DAYS OF ISSUAN~ OR · <br /> W~ IS SUS~D~ FOR I~ DAYS. <br /> <br /> ~ CO~OR ~LATION O~Y <br /> <br />liB. FOR OWHI~R IHSTALLATION$ <br /> <br />Prope~y Ow~r ~ p~) <br /> <br />M~ilir~ Add~a <br /> <br />Cily/~tale/Zip <br /> <br />Ow~r'~ <br /> <br />3. PLAN R~VIEW SECTION <br /> <br />IMarion County does not require a plan review. <br /> We will provide pt~n review service if you complete <br /> Section 5B and subreit two (2) sets of plans and <br /> specifications with this application. <br /> MC I3-34 1/96 <br /> <br /> $85.00 <br /> 4 <br /> <br />~mited Ener~ $20.~ <br /> ~r 1~ amps or vol~ ~.~ -- 2 <br /> <br />D. ~anch <br />· ) ~e fee f~ b~ch cimm~ ~ <br />~ch branch ci~uit $ ~ ~ <br /> <br /> $ 2.~ <br /> <br /> pl~gJlaar,~f~_ervice o~eeder fee <br />Fust branch ci~cui! <br />Each addilional branch circuit <br /> <br />A I. Enler Iota l of fees f~m Sec. ~4 <br />A2. Add 5% s~rcharge (.05 x A 1 ) <br /> Subt~el <br /> <br />B. E~ller 25% o[e line A I for Plan Review <br />(S~c. 3), if rcquir~d $.__ <br />C. Invcsligation Fee(ii'required) $ <br />D. Remspec~OfllFee <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No, <br /> <br /> <br />