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I!Ol~ ~ITY VALIDATION <br /> ccei¥cd By: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Lancaster Dr. NE - Suite C <br /> Salem. O~egon 97305-1398 <br /> <br /> ~4 HR Iml~ction L/a~ 373-4427 <br /> Oltk~: phone S~-SI47 8:00am. 4:30pm <br /> FAX 58~7948 <br /> I <br /> <br />L LOCATION OF INSTALLATION <br /> <br /> PR~ O~ <br /> ~o~ I~1 ~1~.1-1~ I~ I~ <br /> <br />CROSS STR~ETI <br /> <br /> £ <br />I~.OR~CT ~ON · / <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK I~ NOT <br />STAI~ED ~ [80 DAY5 OF ISSUANC3B OR IF <br /> WORK IS SUSPHqDED FOR lq0 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br />I,~t~ Addr~s <br /> <br />tCity, Statc, Zip <br /> ~. I I I I-I I I I-I I I I <br /> Ow~r ~ Signature <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion County docs not require a plan review. <br />We will provide plan review se~ice if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />PERMIT NO: <br /> <br />Dale: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Compl¢,= ,,,d c.~ ~0~.1 in Al be. low) <br />A. Residential Per <br /> <br />NIC <br /> <br />MC 15.$4 7/97 <br /> <br /> <br />