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IFOR CITY VAI.IDATIONI <br /> <br /> Dat~: ..... ' [ <br /> <br />MARION COUNTY ! . <br />!BUILDING INSPECTION DIVISION J <br />3150 LANCASTER DR NE - SUITE C <br />SALEM OREGON 97305-1398 <br /> <br />· ELECTRICAL PERMIT APPLICATION <br /> Please completea/I Sections, t through <br /> <br />I. LOCATION OF IRSTALLATION <br /> <br />cmos; su~:t/Dbccgom: <br /> <br /> mmrrs ^ mx U.o.-~s 'mu~t~ ~D ~q'[~ IF wo~ <br /> <br /> WORK IS SUSPFJ',IDED FOP. ! 80 DAYS. <br /> <br />2/L CONTP--4.CTOR INSTALLATION ONLY <br /> <br />~udllng <br /> <br />Ow~,er's Signhturc: .. <br /> <br />I..g~a6d.:5~ .~d'~ub,dtt tWO (2) s~m of pl~ and <br />I <br /> snem~calmns w~fh fl,~ annlmahnn. <br /> <br />Issued by: <br /> <br />$35.00 2 <br />MO.O0' 2 <br />$~0.00 2 <br /> <br />v'- '"'~' s z~o <br /> <br />$35.00 <br />$2.00 <br /> <br />$40.00 2 <br />~40.00 2 <br /> <br />S35.00. <br /> <br /> ,Edd~'nddldd~'~ b~dch cir~ult <br /> <br />I1;~ I~lline~il (5~r|~ ~' Feedar N~ lncltlded) <br /> <br /> S.50.O0 <br />, tO g[~ctri~ I contracton) <br /> <br /> r O~c&O <br /> · " ': ' ~;.fl. x$.0~ -' <br /> <br /> <br />