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MARION COUNTY <br />BUILDING INSPECTION DIVISION <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 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> TAX ACCOUNT NO. <br /> <br /> JOB ADDRESS <br /> <br /> CITY <br /> <br /> PROPFca~TY OWNER <br /> <br /> CROSS STREET/ <br /> DIP, ECl'IONS <br /> <br /> PRO~ECT DESCRIFrlON <br /> <br /> pERM1TS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED ~ 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />IProperty (please print) <br /> Owner <br /> Mailing Address <br /> City, State, Zip <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (ComplOe and enter total in Al below) <br /> <br /> $85.00 __ 4 <br /> <br /> Owner'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 />MC 15-34 7/97 · <br /> <br />5. FEES <br />Al. Enter tota~ of fees from Sec. ~ $ <br />A2. Add 5% surcharge (.05 x Al) $ <br /> Subtoud $ <br /> <br />Receipt No. <br /> <br />TOTALAMOUNTDUE <br /> <br /> <br />