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FoR CITY VALIDATION] <br />Received By: <br /> <br />Date: <br /> <br />BUILDING INSPEC'IlON DMS1ON <br />3150 Lancast¢r Dr. NE - Suite C <br /> Salem, Or~gnt197305-1398 <br /> <br /> 24 HR Inspection Line 373-4427 <br />Office: phone 588-$147 8:00am - 4:30pm <br />FAX 588-7948 <br /> <br />ELECTRICAL PERMITAPPLICATION ] <br />Please complete all Sections, 1 through 5 <br /> <br />· LOCATION OF INSTALLATION <br /> <br />CITY A~l~t~ ~O I L_ L.J~- <br />PROPERTY OWNER gD ~ ) ~¥~ P~J~ <br /> <br />DI~ONS <br /> <br />PROJECTDE$CRIPTION 5 P,~r- IAI , ~.-I k~tT~ <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIKE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Propcr~y Owner (.otease 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 />Date: <br /> <br />Issued by: ' <br /> <br />4. FEE SCHEDULE (Complet~ and ent*r total in A1 below) <br /> <br />First branch circuit { $35.00 ~,_ ~'-o <br /> <br />5. FEES <br /> Al. Enter total of fees f~om See. #4 <br /> <br />B. Enter 25% &line Al for Plan Review <br /> (See. 3), if required <br />C. Investigation Fee (if t~quired) <br />D. Reinspcction Fee ($2~.00) <br /> <br />Receipt No, <br /> <br />Subtotal <br /> <br />TOTAL AMOUNT DUE <br /> <br />,,~;C I5-347/97 <br /> <br /> <br />