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FOR CITY VALIDATION <br />Received By: <br /> <br />Date: <br /> <br /> 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 /> Off'ice: phone 588-5147 8:00am - d:30pm <br /> FAX 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> P.oNE 15 Io 13 l-I~lq lq I-I ~ I~ Iwlw <br /> cgoss S~T/~ ~ ~ <br /> B~C~ONS <br /> <br />PROJECT DESCRIPTION I" <br /> <br />pERMITS ARE NON-TRANSFER.M~LE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WOPd(IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Elecb'ic al Contractor <br />Mailing Address City <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> City, State, Zip /4~su:l l¢,Ove. ' ~173..~ <br /> Pho.~ i~1o1:~1_~1,./1~,1__I/I/I-71-z <br /> Owner's Signature ,~_ ff/~t__ ~ '~__ ~ <br /> <br />3. PLAN RE¥1EW SF, CT[ON <br /> <br /> Mario~ Collnty does not ~equire a plan Eeview. <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 />Date:. <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter telal in Al below) <br /> <br />sq. ftx $.068 =___ <br /> N/C <br /> <br />FEES <br />Al. Enter total of feas from Sec. <br />A2. Add 5% surcharge (.05 x Al) <br /> <br />B, Enter 25% of line A 1 for Plan Review <br /> (Sec. 3), if requked <br />C. Investigation Fee (if requked) <br />D. Reinspecfion Fee ($25.00) <br /> <br />Receipt No. <br /> <br />Su~otal <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />