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Office: Phone 588-5147 8:00am - 4:30pm <br />I~ ~LX: 588-7948 <br /> <br />~]ool <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF ENSTALLATION <br /> <br /> PI~M1TS APE NON-TRANSFEEABLE AND ID~PIPE IF WORK IS NOT <br /> STARTED WITHLN ] ~0 DAYS OF ISSUANC~ OR IF <br /> WOEK IS SUSPENDED FOR 180 DAYS. <br /> <br />ZA. CONTRACTOR INSTALLATION ONLY <br /> <br />2B..FOR~WI~R INSTALLATIONS <br />Propo~y Owner (plvzse print) <br /> <br />Mailil~tdre~s, ' [ Phone <br /> <br />Ciq,/StateFEip <br /> <br />3. ~M~IREVIEW SECTION <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 $CHEDLTL~ (Complete and enter total in Al below) <br /> <br />Installation, AltoralJoa of Relooation <br />200 amps or less $50,00 <br />201 amps to 400 amps $60.00 <br />401 amps to 600 amps ~ $100.00 <br />601 mnps to 1000 amps $130,00 <br /> <br /> Each additional branch circuit <br /> <br /> (.,~ recl~red by B~ildi~ Ol~ciaO <br /> <br /> ' ---..~q,fl, x $.068= <br />#ofLalmb <br /> <br />5. FEE8 Al. Enter total offe~ from SCCl ~4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> TOTAL AMOUNT DUB <br /> Receipt No. ~ .... <br /> <br /> <br />