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...... MARION COUNTY <br /> FOR C~I~ VALIDATION BUILDING INSPECTION DIVISION <br /> PERMIT <br /> NO: <br /> 3150 Lancaster ~r. NE - Suite C <br /> [Received BY:Date -- Salem' "O~297305:1398-- 0 Date: __ __ <br /> : -- ~lLine 373-4427 <br /> O~$:0Oam <br /> <br /> J ELECTRICAL PERMIT APPLICATIOI~Jl~[ <br /> · <br /> I P/ease complete all Sections, 1 through 5 <br /> I <br /> BUILill[~ IliSpl:~ 101~r~ ~=~.d~a, ~m, Cost (each) Sum <br /> 1. LOCATION OF INSTALLATION <br /> <br /> I-Il I lll <br />CROSS S~ <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. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Pa~in Electric, Inc. 20250 S Molalla Ave. <br />Oregon City, OR 97045 503-657-4958 fax: 557-1059 <br />Contractors License#: 34.4C exp. '10-01-98 <br />Supervisor: 4241-S exp. 10-01-98 <br />Contractors Board Reg #: 35151 exp. 10-12-98 <br /> <br /> 7,:;:;::: ::z: !'_'J .I I I I sl <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner (please print) <br /> <br />Mailing Address <br /> <br />City, State, Zip <br /> <br /> Owner's Signatare <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 />Each additional 500 sq. ft. <br />or portion thereof $15.00 <br />Limited Energy $20.00 <br /> <br />__ sq. ft, x$.068 =__ <br /> <br />2 <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec. ~4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />Receipt No. <br /> <br />Subtotal <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br /> <br />MC 15-34 7/97 <br /> <br /> <br />