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FOR CITY VALIDATION] <br />Received By: <br /> <br />Date: <br /> <br /> MARION COUNTY <br />BUll,fliNG INSPECTION DIVISION <br />3150 l.,a~as~r Dt ~. S ui~ C <br /> Snlem, Oregon 97305-1398 <br /> <br />PERMIT NO: <br /> <br />Date:, <br /> <br />Issued by: <br /> <br /> JUL <br /> MARLO <br />1. LOCATION OF INSTALLATION BOILDIN~ <br /> <br /> PROPERTY OW~R S~]" ~ ~ <br /> I I I-III I-I I I I <br /> <br /> P~S ARE NON-~S~ ~ ~ ~ WO~ IS N~ <br /> ST~ W~ 180 DAYS OF ~$U~CB OR ~ <br /> WORK I$ 8USP~ ~R 180 DAYS. <br /> <br /> 24 HR lmpection Line 3"/3-4~7 <br /> <br />ELECTRICAL PERMIT APPLICATION ] ,4~ F~$CFr~,BULE (Complete and enm' total in Al b~low) <br />Please complete all Sections, I through 5] · N.m~ or hw~-~o., ~ ~.~,,~io~ ~ <br /> A~,,R~I~I Per Unit t <br /> [ ~l~ml,~d: Items CostCeach) St.n [ <br /> <br />nurchase of service c~r fe~der fee / ,~ ~ <br /> <br /> 2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Parkin Electric, Inc. 20250 S Molalla Ave. <br />Oregon City, CE 97045 503-657-4958 fax: 557-1059 <br />Contractors License#: 34-4C exp. 10-01-98 <br />Supervisor: 4241-S exp. 10-01-98 <br />Contractors Board Reg #: 35151 exp. 10-12-98 <br />Metro# 2416 exp. 11-01-98 <br /> <br />[SupervisorLiccnse -.,¢1.,I I I IsI <br /> I <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Properly Owner (please print) <br /> <br /> Mailing Address <br /> <br /> Ciiy, Sta£e, Zip <br /> <br /> Owner's Signature <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion County does not require a plan review. <br /> We will provide plan review service if you complete <br /> Section 5B and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC 15.34 7/97 <br /> <br />5. FEES <br /> <br />Receipt No. <br /> <br />Subtotal <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br /> <br /> <br />