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FOR CITY VALIDATION] <br />Received By: _ <br />Date: <br /> <br />BLTILDING INSPECTION DMSION <br />3130 Lancaster Dr. NE. Suite <br />'Salem, Or~gon 97305.1398 <br /> <br /> 24 HR Inspection Line <br /> Office: phone 588-5147 8:00am - 4:30pm <br /> FAX 5~-7948 <br /> <br />ELECTRICAL PERMIT APPLICA~:ION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> CITY <br /> <br />PROPERTY OWNER <br /> <br />PHONE <br /> <br />CROSS STREET/ <br />DIRECTIONS <br /> <br />PROJECT DESCRIPTION <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 150 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Propeay Owner (please print) <br /> <br /> Mailing Address <br /> <br /> City, Stale, 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 so'vice 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 />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Compl~ and e~ter t~l in Al below) <br /> <br />200 aml~ or less $50.00 ~5 ~' 2 <br /> <br />Each b~ cimuit ~ O $2.~ <br />~h s~ ~e li~ ~.~ ~2 <br /> <br />5. FEES <br /> A LEmer toud of fees from Sec. #4 <br /> A2. Add $% surcharge (.05 x A 1) <br /> <br />Receip~ No. <br /> <br />MC 15-34 7/97 <br /> <br /> <br />