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F-OR CITY VALIDATION <br />Received By: <br /> <br />Date: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Inspection Line 373-4427 <br /> Office: phone $88-5147 8:00am - 4:30pm <br /> FAX 588.7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> Iq/I l-lZClql c, <br /> <br /> PERMITS 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 />Contractors License No~ % -- C <br />Contractor Bo~g No. ~' <br />J Su~iccnse S <br />S ~a%~lte of Supv. Electrician <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (ComplY: and enter total in Al Izlow) <br /> <br />$85.00 4 <br /> <br />2 <br />2 <br />2 <br />2 <br />2 <br /> <br />NIC <br /> <br />MC 15-34 7/97 <br /> <br />FEES <br />Al. Enter total of fees from Sec. #4 <br />A2. Add 5% surcharge (.05 x Al) <br /> <br />B. Enter 25% of line Al for Plan Review <br /> (Sec. 3), if required <br />C. Investigation Fcc (ff requlted) <br />D. Relnspec~on Fee ($25.~0) <br /> <br />Receipt No. <br /> <br />Subtotal <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />