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Fog CITY USg ONLY <br /> <br />Zoning I~y: City: <br />Receipt#: Amouflt: $ <br /> <br />ELECTRICAL PERMIT APPLICATION <br /> Ple. a~e complete all Sections, I through 5 <br /> <br />LOCATION OF INSTALLATION <br /> <br />City: /$~,/~ ~ ~ ~ zip:q7~ <br /> <br />pEI6%ffI~ ~ NON- TRA~$ ~LE ,(ND FJ~PIP. E IF FFOR~ <br />IS NOT ~FART~D FlrltlN 180 D,~Y~ OF I~I],~VCE OR IF <br />FFOR~ IS SUSPENDED FOR 180 DA ¥~ <br /> <br /> CONTRACTOR/NFORMATION <br /> <br />~ai~ing^ddress P. O. BOX 417 <br /> <br />cib~I'AYTON Start: OR , zip:97383 <br /> <br />~: 1-505-769-7124 <br /> <br />C~o~ ti~. No: 24-365C <br /> <br /> FOR O~ER ~TION <br /> <br />.1, PLAN REV1EWSECTION <br />IMm-io~ Coun~ ~ ~ requite <br /> plan ~i~ ~ ify~ ~mpl~c <br /> <br /> Ji/J <br /> E <br /> <br />BUILDING NSPECTION <br /> ~ Raldea~l Per UaiL~l~e lltJ~de~ <br /> l~ ~(~) Sum <br /> I~ SL FI. ~1~ x S110,~-$ 4 <br /> <br /> M~ ~11~ ~ F~ -- x S~2.~ <br /> <br /> ~ ~le~ or ~eede~ ~ eot la,lane branch Clreal~ ~e ~t~a D) <br /> <br /> 401 m~ x <br /> <br /> ~ I~1~ x S3~.~- $. .2 <br /> ~ ~y x S 55.~= S 2 <br /> <br /> 201~4~ · ~55.~ = $, , .2 <br /> <br /> New, ~ or Exte~lea eer ~aael <br /> <br /> b)~ ~ c~ <br /> <br /> ~ifi~B~C~ x S 3.~ - $ <br /> ~ M~elllneo~ (~ er F~er Not Inzlnd~) <br /> <br /> ~ ~ ~ x $ 55.~ - $ 2 <br /> <br /> G. Mlaor I~oa <br /> h~ of 10 ~ ~ $10.~ ~ <br /> (Sold ~ m ~1 ~) <br /> H. ludul~l ~ut <br /> 0~ Fami~ ~llieg F~: ~. F~ x <br /> <br /> ~lRng ~mlt ~b ~or ~ng~ Family ~lUng* Only) N/C <br /> O~g~ ~ ~qulred ~ the Buffing Office) <br /> <br /> 5. <br /> Al. En~To~ F~m <br /> ~ A~ S~ S~ (.05% x <br /> <br />SUBTOTAL: <br /> <br />MC 15-34 Rev 9/98 <br /> <br />B. Enter 30% of linc ^1 for Pbm Review <br />C. ~v~n F~ ~ ~u~ <br />o. ~ F~ (S50.~) <br />E. A~ P~ R~ (62.50~, <br /> m~ on~ho~) <br />F. ~n for wh~ no f~ ~ ~if~y <br /> ($62.~0~, m~ one ho~) <br />G. ~n OuU~ N~ B~e~ Hou~ <br /> $62.50~, m~ ~ hour) <br /> <br /> <br />