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I BUILDING INSPECTION DMSION PERMIT NO: <br />E, OR CITY VALIDATION] 3~5o Lm~.¢astcr Dr. NE- Suite C <br />I Salem, Oregon 97305-1398 <br />Received By: __ I , Date:__ __ <br /> <br /> Date: ] 24 HR Inspection Line 343-4427 <br /> -- I Office: phone SSS-SI4? !.~0~Im - 4:$0pm Issued by: __ __ <br /> <br />I Please complete all Sections, 1 through 5 BU~ 2 .~ ! ?: <br /> <br /> 1. LOCATION OF INSTALLATION ~]A~,[O~ - ~ or le=s sss.oo __ 4 <br /> TAX ACCOUNT NO. or poraon thereof $15.00 <br /> <br /> 201~mps to 400 ~ $~0.00 2 <br /> sot ~p, to tooo ~ps / smoo <br /> <br />I PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS ROT 201 amps to 400 ~ $40.00 __ 2 <br />lA. CONTRACTOR INSTALLATION ONLY mw, .~t~'~o~, or Ext~slo. Per <br /> <br />2B. FOR OWNER INSTALLATIONS e~k of to laths ~5.oo e~h ~0,oo <br /> (~d on/y to d~ctr/m/contracwr0 <br />Property Owner (ptea~e print) H. O~r <br />Mailing Address (As r~lui~l by Building Officials) __ <br /> <br />Owner's Signature 5. FEES <br />3. PLAN REVIEW SECTION m. Add S% ~ (.OS ~ AO S <br />Marion County does not require a plan review, a. Eat~ 2s% o~u.e At ~ ~ ~-,i,~ <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and s <br /> with this application. $ ~ <br /> <br />(Sec. 3), if required $ <br />C. lnve~gatlon Fee (if required) $ <br />D. R~impectlon Fee ($25.00) <br /> TOTAL AMOUNT DUE <br />Receipt No. __ <br /> <br />MC 15-34 7/97 <br /> <br /> <br />