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FOR CITY VALIDATION } <br />Rozeived by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVI~LOPMENT CENq~R <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Insp~tion Line 3734427 <br />Office: Phone 558-5147 $:00am - 4:$Opm <br />FAX: ~g-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please vomploto ~ll 8oattOa$, i through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> ]pERMITS ARE NON-TRANSFEI~dkBLE AND EXPIRE IF WORK IS NOT <br /> STARTED VflTHIN 180 DAYS OF ISSUANCE OR IP <br /> WORK I$ SUSPEBIDFe. D I~OR 150 DAYS, <br /> <br />2A. COlWrRACTOP. INSTALLATION ONLY <br /> <br />_P_ropcny Ownec ........ ',1 Phone <br /> <br />3. PLAN REVIEW SECTION <br /> <br />IMarion County does not require a plan review. <br /> We will provide plan review service if you complete <br /> Section 5B aad submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC 15-34 1/96 <br /> <br />PERMIT NO: <br />Date: <br /> <br />Issued by: <br /> <br />4+ Fl/l/$CH]tDUL]~ (Complete and entce total ia Al below) <br /> <br /> R~idontial <br /> Unit <br /> <br />200 am~ or I~ $~,~ ~ 2 <br /> <br />~ 1 am~ to ~ am~ $1~,~ , 2 <br />~1 ~ to 1~ ~ps $1~.~ ~ 2 <br /> <br />Rc~ct only $~,~ ...... 2 <br />a) ~e fee for ~ch ck~ui~ ~ <br /> <br /># of Labela ~q' J/ $' 068 = ~CC~ <br /> <br />5. FEES Al. Enter total of feea from Se~,//4 <br /> A2. Add 5% aureharg~ (.05 x Al) <br /> <br />~btota[ <br /> <br />B, Enter 25% of line A I for Plan Review <br />(Sec, 3), if required $, <br />C, lavestigation Fe~ (if ~q~tirgd) <br />D. Relnapeetio0 P¢~ ($25.00) <br /> <br /> TOTAL AMO1JI~ D~E $,~ <br />Rc~ipt No, <br /> <br /> <br />