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IFOR CITY VALIDATION] <br /> Rec¢ivexJby: ] <br /> Date: / <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete al~ Sections, I through 5 <br /> <br />1- LOCATION OF INSTALLATION <br /> <br />Dicecfiom <br /> <br />MARION COUNTY BUILDING INSPECTII~N J ({~ <br /> COMMUNITY DEVELOPMENT CENTER / ~'} ~'~'"~ f-~ ~ :;a <br /> <br /> 0~ 588-5147 8:~ a.m. - 4:30 p.m, 18.~ <br /> F~: SSS-?94g BUILDING i.~UNTy <br /> ~VaPECTIO~ <br /> 4_ F~ S~ (Complete and cnt~ mini in Al below) <br /> Number of Illspectiona <br /> Rmid~ntlal <br /> Per <br /> Unit <br /> ,I <br /> ~vie~Inelud~: Items Cost (~aeh) Stun <br /> 10~ sq. fl. or leas $85,~ 4 <br /> ~eh additional 5~ sq. fl. <br /> or ~nion ~e~of $15.~ <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTFJD WITHIN 180 DAYS OF iSSUANCE OR IF <br /> WORK IS SUSPENDE. D FOE 180 DAYS, <br /> <br />Mailing Adtlc~s~ ' <br /> <br />Con,actor's Lio~ns~ No. <br /> <br />2B. FOR OWNIER INSTALLATIONS <br /> <br /> F~,petty Owner (ple~e print) <br /> Mailing Address I ~honc <br /> City/State/Zip <br /> <br /> 3. PL~RE~W SECTION <br /> <br /> Marion County does not require a plan review, <br /> We will provide plan review se~ice if you complete <br /> Secdon 5B and submit two (2) sets of plans ~d <br /> specifications wi~ ~is application. <br /> <br />~ Lf-.~41~ <br /> <br />Installation, Alt~tstioa ot Relocation <br />200 amps or I~ <br />201 amps to400 amps <br /> <br />Pa~k of 10 labels ~} $5.00 each <br /> <br />$50.00 2 <br />$60.00 2 <br />$I00.00 2 <br />$130.00 2 <br />$3(X).00 --~. 2 <br />$40.00 ,, 2 <br /> <br />$35.00 __2 <br />$40.00 ____2 <br />$80.00 2 <br /> <br />$ 2.00 __ <br /> <br />$ 2,00 <br /> <br />$40.00 2 <br />$40.00 2 <br /> <br />$40,00 2 <br /> <br />$35,00 <br /> <br />$50,00 , <br /> <br />__Ul. E, x $.~6 =__ <br /># of Label* _.lq/.~. <br /> <br />5, FEES <br /> Al. Eater Iotal of 1'~o$ fYoln Sec, #4 <br /> A2. Add 5% anmharge (,03 x Al) <br /> Subtotal <br /> <br /> B, Erltae 25% iff llne A 1 lbr Plan Review <br /> (Sec. 3), if ecqui~d <br /> C, lnvesligalion Fee <br /> D. Reirmpection Fee ($25.00) <br /> <br /> TOTAL/LMOUN'r DUE <br /> Receipt No. <br /> <br />$ <br />$ <br />$ <br /> <br />$. 2560 <br /> <br /> <br />