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i FoRcrl~ U~ ONLY <br />p,~eived By: .ti;It=: <br /> By: ~ , City: <br /> <br />W~U IU:Ul F~ 1 ~Ua 5~B 7948 <br /> <br />[ ELEt'J'~ICAL PERMIT APPLICATION <br /> Pt~w~e ¢om~le~ all Set'dons, I through $ <br /> <br />PERMIT~ AR~ NO~-TR~ISF~ A~O F~PIRE IF WOI~ <br /> $~ FOR l~ ~ <br /> <br />~ AC&E E~ec~r~c <br /> <br /> Salem S~ 0R ~P:97303 <br /> 503-363-2301 <br /> <br /> 503-363-~302 <br />~~ 591 <br /> <br /> o - <br /> <br />I ~ t~ PROP~ O~ ~ o~, ~ ~ or ~iH ~ ~ <br /> <br />MC I$-3~- Rev 9/98 <br /> <br />~%RION BLDG INSP 1~003 <br /> MARION COUNTY BUILDING INSPECTION <br /> 3150 Ls~cast~r Dr, ~ - Sui~C <br /> ~I~ Omg~ ~ <br /> 8~m - 4:3~ ~ ~ ~n ~ 373~27 F~ 588-7~8 <br /> <br /> N~ oil~ ~ ~ <br /> <br />(each) Su~ <br /> <br />~ x $52.00=$ 2 <br /> <br />Al, ]~n~r total off~ from ,,%x:, .-94 $ <br /> <br /> ~ o~half ~r) <br /> <br /> (~, ~ o~ ~r) <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />