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FOR CITY VALIDATION] <br />Rex~eived by: . <br />DaW:.~ ,,, ,, <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> <br />285 Church St NE · Roon~ 132 <br />Salem, OR 97301 <br /> <br />24 Hr Inal~etion Lille: 5811-7904 <br />Office: 5F,8~-5147 8:00 a.m. - 4:30 p.m. <br />FAX: 588-7948 <br /> <br />iELECTRICAL PERMIT APPLICATION <br />,,P/ease complete all Sections, I through <br /> <br />1, LOCATION OF INSTALLATION <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEB $CHF~DD'I.~ (Complete and enter total in A 1 bolow) <br /> <br />IPERM1T~ ARE NON-TR~NS~RABL~ AND EXPIRI~ IF WO~ IS N~ <br /> STARED WITHIN 1 ~) DAYS Og iSSUANCE OR 1~ <br /> WORK 1~ SUSP~D~ NOR 180 DAYS, <br /> <br /> ~. CO~RACTOR ~ST~LATIO~ O~Y <br /> <br /> ................. <br /> <br /> FOR OWNHR RqSTALLATIONS <br /> <br />Property Ow~at (plea~print) <br /> <br />Maillng Addr~ ] Phone <br />City/$h~lodZip <br />Owners Signature: <br /> <br />3, PLANREVIEW SECTION <br /> <br /> Marion County does not require a Naa 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 />Mc Lg-.{4 12ZO4 <br /> <br />200 ampa or <br />201 ~mm m 400 amps ,',ii'/ <br />401 aml~ to 600 ampa <br />601 amps to 1000 <br /> <br />(~ requlrcd by Boilding <br /> <br /> $50,00 <br /> <br />$100,00 3 <br />$130,00 --,-- 2 <br />$300,00 ----- 2 <br />$40,00 2 <br /> <br />$35,00 -- 2 <br />$~).00 , 2 <br />$~),00 .... 2 <br /> <br />$ 2,00 <br /> <br />$35.00 ~ <br />$40,00 2 <br /> <br />S~.00 2 <br /> <br />$35,00 <br />$50.0O ..... <br /> <br />5 .7. lc> <br /> <br />$ <br />$ <br />$ <br /> <br />TOTAL AMOUNT DUE <br /> <br />*q R.x$.06 =__ <br /> <br /> <br />