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---. / MARION COUNTY <br /> <br /> . Sl ~p ~C~TER DR NE- SUITE C <br />J~OR ~~N~ SALEM O~ON 97305-1398 <br /> <br /> ~ h~ ~p~on ~, 37~27 <br /> ~llll~l~ I~qD~~1~7 8:OOm-4~Opm <br /> <br />ELECTRICAL PE~ffAPPLICA~ON ] <br /> ~e complete ~1 ~tiona, I t~rougb ~ ~ <br /> <br />Job Address <br /> <br /> worn( m sus~o ~OR J ~0 DA <br />2,~ CONTRACTOR INSTALLATION OI~,Y <br /> <br />Parkin Electric, Inc. 20250 S Molalla Ave. <br />Oregon City, OR 97045 503-657-4958 fax: 557-1059 <br />Contractors License #: 34-4C exp. 10-91-97 <br />Supervisor: 4241-S exp. 10-01-98 <br />Contractors ~a~ Reg #: 35151 ex~, 10-1248 <br />Metro# 2416 exp. 11-01-97 <br />Owner: <br /> <br />pERMITS A RE NON-TILt~N$1~JRABL~ AND ~ IF'WORK IS NOT <br /> <br />STAIci~O ~ 180 DAYS OF ISSlJANCIi OR ~ <br /> <br />Signature of Supcrvisin~ Elearichm <br />Supervisor a ].,kcnsc No. ' I Fflofle// <br /> <br />2B. FOR OWNBR INSTALL &T~ONS <br /> <br />Ptolmfly Owner (pl~oprint) <br /> <br />Mailing Address <br />Cily/StateJZlp <br /> <br />3. PLANRBVIffiW S]~CTION <br /> <br />Marion County does not require a plan review.. <br />We will provide plan review servico if you ¢omplete <br />Section 5B and subalit two (2) sets ofplans and <br />specifications with this application. <br /> <br />PERMIT NO: <br />Date: <br /> <br />Issued by: <br /> <br /> lasta~fioe, Al~atlo~ ~ Relocallo~ <br /> 200 ~ or 1~ $~.~ 2 <br /> ~1 ~ m ~-~ S~ 2 <br /> <br /> ~1 ~lo 1~ $1~ 2 <br /> ~r 1~ ~ or~ ~.ffi 2 <br /> ~t~7 ~.~ 2 <br /> <br /> C. T~a~ <br /> ~ ~5.~ 2 <br /> ~lm~m~ $ffi.~ 2 <br /> <br /> D. Bran~ <br /> <br /> _,_ :- . -..~:- ~ <br /> ~ b~ c~t $ Z~ <br /> <br /> ~ ad~t~ b~ c~t $ 2.~ <br /> <br /> ~si~~ ~.~ 2 <br /> <br /> F.~ a~k~ ~oa <br /> ~ ~ aa~ h ~yof ~o <br /> ~ ~ ~ $35~ <br /> <br /> hck of 10 I~ ~ ~.~ ~ch <br />, (~d o~y ~ ~1 <br />H. 0~ <br /> <br /> A~n Dw~ ~oal ~ .~q. fi. x $.068 - <br /> ~d~ P~ ~ ff 6f~~ N/C <br /> <br />Al. ~ttcr total of fe.~ from S~¢. ~4 <br />A2. Add 5% ~char~ 605 x Al) <br /> <br />~;bto~al <br /> <br /> <br />