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FOR CITY VALIDATION <br />Received By: <br /> <br />Dale: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Or. on 97305-1398 <br /> <br /> 24 HR lnsl~-iion Line ~7~'/ <br /> OffiCe: phe~e $88-5147 8:00am - 4:30pm <br /> FAX g88-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all SecgonS, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> P~S ~ NON-~S~B~ ~ ~ W WO~ ~ NOT <br /> ST~D ~ 1~ DAYS OF ISSU~ OR IF <br /> WO~ I$ SUS~D~ FOR 1~0 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Prope~y Owner (please print) <br /> <br /> Mailing Address <br /> <br /> C{~, State, Zip <br /> <br /> Owner's Signature <br /> <br />PERMIT NO: <br /> <br />Date:, <br /> <br />Issued by: <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 />4. FEE SCHEDULE (co~ aaa enter total in Al <br /> <br />~q. fl, x $.068 =__ <br /> <br />2 <br /> <br />2 <br />2 <br /> <br />2 <br />2 <br /> <br />2 <br />2 <br />2 <br /> <br /> ~ ~ s35.oo <br /> <br />F, ~ sddiflmml lmp~loa <br /> <br />Ig. O~r <br /> <br />FEES <br />Al. Enter total of fees from Sec. ~4 <br /> <br />R~ceipt No, <br /> <br />Subtotal <br /> <br />MC 15-34 7/97 <br /> <br /> <br />