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Received By: · ~ t~ ~ ,~ Senator Bldg. No, 226 <br /> <br /> ~ ~,[~'~ Code-A-Phone4.30 RM -8:00A M <br /> <br /> S-~ ' ELECTRICAL PERMIT APPLICATION <br /> <br />Owner:~ ~_ _ , Phone: 'Mailing Addres~" <br /> <br />Job Address; ,, Site NO.; Cross Street: / <br /> <br />Supervising Electrician: "~ ~ Phoner Address: <br /> <br />Supervlsln9 [ , ~ew ~ adOitloa ~ O~upancy <br />Electrician~ No,; AlteratiOn S~~atlon <br /> <br />__ Resider ~, ~J ~ . ~ ~ ......... @$ 50.00 <br /> <br />__ Servic~ i ..... @ $ 4&00 <br />__ 8ervic~ . "'" . @$ 100.00 <br />__ 8ervic~ ~ ..... @ $ 200.00 <br /> i ..... @ $ 450.00 <br /> <br />__ Feeder ......... ¢[~ $ 120.00 <br />~ '~^~ Eachsupplyformobilel3ome(Connectlon) ........................... @$ 25.00 <br /> <br />__ D, Eachelectdcslgnorbuflinelightieg .............. . ...... <br />__ E. Each swimming pool (bonding) ................................... @ $ $0.00 <br /> BRANCH CIRCUITS <br /> <br />__ Other (as per NEC and Building OfficiaD ......................................... · <br /> On-Site Technical Review (apply directly at Marion County only) ', '~, <br /> Industrial Plant Inepectlon (apply directly at Marion County only) ........... ...... ..... ' <br />.___ Reinspe¢:ioe Fee ................................................ @ $: 20,00 , <br /> FEE <br /> STATE SURCHARGE <br />Please return COMPLETE APPLICATION ~'~ <br /> INVESTIGATION FEE <br />with the indicated fee, FLEET SURCHARGE <br /> <br /> Job No: <br /> <br /> (Owner de~n; hm own wo~) <br /> <br /> <br />