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FOR CITY VALIDATION <br />Received By: <br /> <br />Date: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DMSION <br />3150 Lancaster Dr. NE - Suite C <br /> Salen~ Oregon 97305-1398 <br /> <br /> 24 HR Inspection Line 373-4427 <br /> Office: phone 588-5147 8:00am - 4:30pm <br /> FAX $88-?948 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> TAX ACCOUNT NO. <br /> <br />PROJECt DESCRIFTION <br /> <br />PERIvHTS 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 Cily <br /> <br />FAX ~ .~ <br />s~p~,~o~ u,~ S <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />!MailingAdd~ss gO. ~'~ ~ 7-~/ ' <br /> <br />I I 1o 1 /-17 I-I 1 <br /> <br /> M~on CounW does not r~u~e a pl~ ~view. <br /> We will ~ovide pl~ w~ew ~ice if you complete <br /> Sec~on 5B ~d sub~t ~o (2) se~ of plus ~d <br /> s~cifica6ons wi~ ~s application. <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complem a~d enter total in Al below) <br /> Number of Impecfi~ per pemfit allowed <br /> <br />Each sign or outline lighting $40.~0 <br />Signal circuit(s) or a limi~i energy <br /> <br />N/C <br /> <br />FEES <br /> <br />D. Re~nspecdon Fee ($25.00) <br /> <br /> TOTAL AMOUNT DU~ <br />Receipt No. <br /> <br />MC 15-34 7/97 <br /> <br /> <br />