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FOI~ CITY VALIDATION <br />Received By: <br /> <br /> MARION COUNTY <br /> BUH~DING INSPECTION DIVISION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR lmpec~ Lfne 3~3-4427 <br /> O~ce: phone 588-$147 8:00am - 4'.~pm <br /> FAX ~88-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />TAX ACCOUNT NO. <br /> <br />CROSS STREET/ <br /> <br />PROIF-CT DESCRIPTION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR 1~ <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />I Electrical Contractor <br />Mailing Address City <br />FAX <br />Contractor Board Peg No. <br />Supervisor License S <br />Signatme of Supv. Electrician <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> ,9,0_ <br /> <br />3. P~ ~V~W SECTION <br /> <br /> M~on CounW does not r~uire a pl~ renew. <br /> We will provide pl~ review semice if you complete <br /> Section 5B ~d sub~t ~o (2) sets of Pl~s ~d <br /> s~cificafions wi~ ~s application. <br /> <br />Issued by: <br /> <br />sq. ~. x $.0~8 =__ <br /> <br />B. Enter 23% of line A1 for Plan Rzview <br /> (Sec. 3), if required <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($25.00) <br /> <br />Receipt No. <br /> <br />Sui,tot~ $ <br /> <br />MC 15-34 7/97 <br /> <br /> <br />