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FOR CITY VALIDATION <br />Received By: <br /> <br />Date: <br /> <br />BUILDING INSPECTION DMSION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Inspection Line 373-4427 <br />Office: phone 588-5147 8:00am - 4:30pm <br />FAX 588-794~ <br /> <br />Date: <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />I <br /> CROSS STREET/ . <br /> <br /> PERMITS ARE NON-TP~NS~ERABLE AND EXPIRE/IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR I$0 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Property Owner (please prin0 <br /> <br /> Mailing Address <br /> <br /> City, State, Zip <br /> <br />Own~'s Signature <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 />4. FEE SCHEDULE (com01~e and enter total in A1 below) <br /> <br />(As required by Building Officials) __ <br /> <br />5. FEES ~ <br /> A2. Add 5% sua'chatge (.05 x Al) $ <br /> <br />D. Reins0ectlon Fee ($2~.~0) <br />Receipt No.~ <br /> <br />MC 15-34 7/97 <br /> <br /> <br />