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IFOR CITY VALIDATION <br />Received By: <br /> <br />Date: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Lancast~ ~. ~ - Suit~ C <br /> Salem, Oregon 9730S-1398 <br /> <br /> FAX <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> crrY t' <br /> RoP mowm 4 or_ (.o <br /> <br />cRos , // <br />D~ONS <br /> <br /> ST~D ~ 1~ DAYS OF ISSU~CE OR ~ <br /> WORK IS SUSP~ FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ON <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />PropeR-/Owner (please print) <br /> <br />Mailing Address <br /> <br />CRy, State, Zip <br /> <br />PERMIT NO: <br /> <br />Date. <br /> <br />Issued by: <br /> <br />4, FEE SCItEDULE (Complet~ and enter tolai in A1 below) <br /> Nun~er of Inspections per pe~mk allowed <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 />FEES <br />Al. Enter tolal of fees from Sec./+4 $ <br />A2. Add 5% surcharge (,05 x Al) $ <br /> Subtotal $ <br /> <br />TOTAL AIVlOUNT DUE <br /> <br />MC 15-34 7/97 <br /> <br /> <br />