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FOR CITY VALIDATION <br />Received By: <br /> <br />Date: <br /> <br />BUILDING INSPECTION DMSION <br /> 3150 Laacasm' Dr. NE - Suite C <br /> Salem, Oregon 97305-139g <br /> <br /> 24 HR InSpection line 373.4427 <br />Or,ce: phone ~88-$147 8:~am - 4:30pm <br />FAX S88-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete afl Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />TAX ACCOUNT NO. <br /> <br />JOB ADDRESS ]~ <br />CITY · ~ <br />PROPERTY OWNER ~ [~.; <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. J <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />City Salem <br /> <br />mec~ Comm~or Judson' s INc. <br />Mailing Address ~ 12669 <br /> <br />Sign,~ure of Supv. El~rlclan <br /> <br /> FOR OWNER INSTALLATIONS <br /> <br />Propgrty Owner (please print) <br /> <br />Mailing Address <br /> <br />City, State, Zip <br /> <br /> Owner's Sigmm~ <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 SB and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC 15-34 7~7 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Compl~ ~ ~r tom in Al below) <br /> <br />5. FEES <br /> Al. £nter toad of f~ from Sec. g~4 <br /> A2. Add 5% ngcharge (,05 x Al) <br /> <br />Subt~al <br /> <br />B. Ente~ 25% of line Al for Plan Review <br /> (Sec. 3), if requlred <br />C. Investigation F~e 0 f required) <br />D. R¢inspection Fee ($25.00) <br /> <br />Receipl No. <br /> <br /> <br />