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' --IFOR CITY <br /> VALIDATIONI <br />IReceived By: <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 /> Office: phone ~-$147 8:001ma - 4:30pm <br /> FAX ~8go7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br /> 1. LOCATION OF INSTALLATION <br /> iT ^Oco o. <br /> <br /> c~. <br /> PROPERTY O~R <br /> <br />"l CROSS <br /> [ D~ONS <br /> <br /> [ PRO~E~ DESC~ON <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 />Mailing Address City <br /> <br />FAX ~. ~. <br /> <br />Contractors License No. O ~ I 7~J -- C <br />Contractor Board Reg No. <br />Supervisor License t~ ! 7g0'- S <br />Sigmture of Supv. Electrician t/~/~ /l,./~a~ <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner (please print) <br /> <br />Mailing Address <br />City, State, Zip <br /> <br />3. PLAN REVIEW SECTION <br /> Marion County does no~ 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 />PERMIT NO. <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and ent*r total in A1 Iglow) <br /> <br />$85.00 __ 4 <br /> <br />$15.00 <br />$20.00 <br /> <br />5. FEES Al. Enter total of fees from Sec. <br /> A2. Add 5% saxchalge (.05 x Al) <br /> <br />TOTAL AMOUNT DUE <br /> <br />Receipt No.. <br /> <br />MC 15-34 7/97 <br /> <br /> <br />