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~R CiTY VALiDATiONI <br />Keceived by: [ <br />Date: ....... <br /> <br />COMMUNITY DEVFLOPMEN F CENTER <br /> 285 Church St NE; · Room 132 <br /> <br /> Date: <br /> ~ Hr lasp~tion Line: 58~79~ <br /> Offi~: 58~5147 8:~a,m.-4:30p,m, <br /> F~: 588-~948 ISSu~ <br /> <br />IELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, 1 through <br /> <br />L LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXpIRI~ IF WORK IS NOT I <br /> STARTED WITItlIq lEO DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR I g0 DAYS. <br /> <br />CONTRACTOR INSTALLATION ONLY <br />Sig,!~:u~e o f ~ upervifing El~,~rleian t~t~ .. <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />plrapetty Owner (ple~tse prim) <br /> <br />Mailing Address ~ Phone <br />Owner'~ Signature: <br /> <br />:3. PLAN REVIEW SECTION <br /> <br />IMarion County does not require a plan review, <br /> We will provide plan review service ffyou complete <br /> Section 5B and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC I,%,I4 12~14 <br /> <br />4. FEE SCHEDULE (Complete and enter total il/A 1 b~low) <br /> Nmnben'ol'Inspe~tiona per permit allowed~ <br />A. <br /> Re~i6~ntial <br /> Pea- <br /> Unit <br /> <br />R. Miaeollanerous (Service et Fe~lor Nm Includ~:l) <br /> Eadl pump or i~igalion civic ........ <br /> ~ch si~l or outline lighting <br /> Signal *i~oit0) or a limited ~ll~gy <br /> <br />F, Each additional Insp~tion <br /> <br /> Pack of 10 lab~l~ ~ $5,~) meb <br /> (~old oMy lo el~trieal eontraClOrS) <br /> <br /> (~ required by Bnildi~, O~claO <br /> <br />$50.00 __ 2 <br />$60.00 __ 2 <br />$ I00.00 __2. <br />$130,00 --.- 2 <br />$3~0,00 __. 2 <br />$40.00 ..... 2 <br /> <br />$35.00 2 <br />$40.00 2 <br />$80,00 __. 2 <br /> <br />$ 2.(X) __ <br /> <br /> SS.rD <br />:::'2. I <br />$40,00 __ 2 <br /> <br />$40,~ __ 2 <br /> <br />$~5,00 , <br /> <br />$50,00 <br /> <br />x$,06 = <br /> ~ <br /> <br />5. FEES <br /> <br />A2. Add 3% surcharg~ (,05 x A 1) <br /> <br />8obtotnl <br /> <br />B. Enter 25% of lin¢ A 1 ibc Plan Review <br /> (Sec, 3), if requited <br />(7, Investigation Fee (if required) <br />D, Reimpeetion Fro ($25.(10) <br /> <br /> TOTAL AMOUNT DUI:*. <br /> Receipt No. __ <br /> <br />$ <br /> <br />,.::5 e. q$ <br /> <br /> <br />