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~0R~CITY VALIDATIONI <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br /> 3150 Lancasl¢~ Dr. NE - Suit~ C <br /> Salem, Oregon 97305-1398 <br /> <br /> Office: 8:001an - 4:30pm <br /> <br />PERMIT NO: <br /> <br />Date. <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />JOB ADDRESS <br /> <br />PROPERTY OWNER <br /> <br />CROSS STREET/ <br /> <br />PROJECT DESCRIPTION <br /> <br />pBILMrfS 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 />2B. FOR OWNER INSTALLATIONS <br /> <br /> Property Owner (please print) <br /> <br />Mailing Address <br /> <br />City, State, Zip <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 />(Complete and ~nt*r total in Al b~low) <br /> <br />$~o.oo 50 2 <br /> <br />$35.00 <br /> $2.00 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br />FEES <br /> <br />A2. Add 5% surcharge (.05 x Al) <br /> <br />B. Enter 25% of ]iae A 1 for Plan R,view <br /> (Sec. 3), if reqair~ <br />C. Investigation Fee (if required) <br />D. R~inspection Fe~ <br /> <br />Receipt NO, <br /> <br />Subto~l <br /> <br />$ <br />$ <br /> <br />MC15-347~7 <br /> <br /> <br />