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I FOR CITY VALIDATION1 <br /> Received by:. _ ~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY D~VELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />IELECTRICAL PERMIT APPLICATION <br /> , P/ease complete all Sections, I through 5 <br /> <br />1_ LOCATION OF INSTALLATION <br /> <br />24 Hr In~p~ctiofl Lifl~; 588-7904 <br />Office: 588-5147 8:00 a.m~ - 4:30 p.m. <br />FAX: 588-7948 <br /> <br /> PERMITS ARt[ NON-TRANSFERABLE A ND EXPIPJE IF WORK IS NOT <br /> STARTED WITHIN tgi) DAYS OF IS$,UANCE OR IF <br /> WORK IS SUSPI~/DEO FOR 1 g0 DAYS, <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Mailing Address <br /> <br />I Iob N~. <br /> <br />Sign~tt~ of Supervising Eleoai¢ian <br /> <br />2B. FOR OWNBR <br /> <br />Px, peay Owner <br /> <br />Mailing <br /> <br />Cit y/SmtdZip <br /> <br />Owner's Signature <br /> <br />PERMIT NO; <br /> <br />Date: <br /> <br />Issued by: <br /> <br />~mited ~norgy $20.~ ~1 <br /> <br /> ~0 ~nps or le~ $35.00 ~ 2 <br /> p~haae.o~twiee of fe~ <br /> <br /> ~eh $~ or outline light~ ~,OO ., 2 <br /> (~ ceqoi~d by ~ild~g O~e&O <br /> <br />3. PLAN REVIBW SECTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application, <br /> <br />MC 15-.t4 IZzf~ <br /> <br />5, FEES <br /> A 1. Enter loud of teen from See, #4 <br /> A2. Add 5% surcharge (,05 x Al) <br /> <br />Pmbtma[ <br /> <br />B, Enter 25% of line A I for Plan Review <br />(Sec, 3), if wquired $__ <br />C, Investigation Fee (ift~qtfired) <br />D. R¢ins@eetion Fee ($25,00) <br /> <br /> <br />