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IFO~R CITY VALIDATION <br /> Received By: <br /> I <br /> Date: [ <br /> <br /> MARION COUNTY <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-$147 8:00am - 4:30pm <br /> FAX $88.7948 <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> TAXACC°U~N°' I~-IS' I~ I~ <br /> JoB ~D.~SS <br /> <br /> ~.o~ I~lo' <br /> CROSS s~/ <br /> <br /> WORK IS SUSPENDED FOR 180 DAYS. I <br />A. ~NTRACTOR INSTALLATION ONLY <br /> <br />-~ec=trical Contractor <br />Mailing Address City <br />Phone <br />FAX <br /> <br /> Contractors License No. ~ C <br /> Contractor Board Reg No. <br /> Supervisor License S <br /> Signature of Supv. Elec~clan <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Property Owner (please print)~ <br /> Mailing Address J~. t~. <br /> <br /> ~ I~lo I~ 1-17 I~l~l-I/I/I~l~ <br /> <br />3. PLAN ~V~W SECTIOn' <br /> <br />Marion County does not require a plan r~view. <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 />PERMIT NO: <br /> <br />Date:. <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al below) <br /> <br /> $85.00 4 <br /> $15.00 <br /> <br /> Services or Feeders (Does not include branch cir~ults, s~ section D) <br /> <br />Receipt No. <br /> <br />TOTAL AMOUNT DUE <br /> <br />MC 15-34 7/97 <br /> <br /> <br />