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FOR CITYVALIDATION[ <br />Re,~eived.by: <br />Date: <br /> <br />MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 LANCASTER DR NE - SUITE C <br />SALEM OREGON 97305-1398 <br /> <br />PERMIT NO: <br /> <br />D~O: <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Plbase complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Cross 5trce~/Dh'ecfiom: ~ <br />Job De.~ripdon: <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Property Ovam~- ~oletao/~rt~t) <br /> <br />Mailip~ Addre~ <br />City/Stata/Zip <br /> <br />Phone <br /> <br />O~ncr's Signature: <br /> <br />4. F~E SCH~iI~I'[.~ (Complete nndentcr to~ h At b~lo,.v) <br /> N,u.-u b~.~ of insp~cdous p~x p~rmk allowed <br /> <br />550.00 . 2 <br />$60.00 2 <br />510O.00 2 <br />$130,00 2 <br />5300.00 2 <br />540.00 2 <br /> <br />$35.0O 2 <br />$40.0O 2 <br />5~.0O 2 <br /> <br />5 2.0O <br /> <br />$35.00 <br />$ 2.00 <br /> <br />$40.00 2 <br />$40.00 2 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br />rq. fi. x 5.068 = <br /> N/C <br /> <br />$ <br />5 <br /> <br /> <br />