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FOR CITY VALIDATION[ <br />RecorDed by: ~ <br />Date; ,, [ <br /> <br />MARION COUNTY BUILDING I~SPI~CTION '~'~i~f~V~ <br />COMM UNITY DEVELO?MENT CENTER ~F~I~ <br /> <br /> Date: SEP 2 7 <br /> ~ Hr insp~tlon Lin~: <br /> o~: ~ss-z~n7 ~:~ ~m.- n:~0 ~..,. ~Aal0~ COUNTy <br /> F~: 5~8-794~ I~u~ ~ ~ ..... <br /> <br />" ELECTRICAL PERMIT APPLICATION <br /> <br />1, LOCATION OF INSTALLATION <br /> <br />PERMITS ARE N~>N-TRANS~BLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN I~l BAYS OF ISSUANCE O~ IF <br /> WORK IS SUSPENDm FOR 180 DAYS. <br /> <br />CONTRACTOR iNSTALLATION ONLY <br /> <br />~l ~OR OW~ INSTALLATIONS <br />Properly Owner (pleascpt'inO <br /> <br />Mailing Addocaa Phone <br /> <br />City/State/Zip <br /> <br />Own~r)a Signature: <br /> <br />3, PLAN REVIEW SECTION <br /> <br />Marion County does not require a plan review. <br /> <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 />~ l,Y-fl4 12Z04 <br /> <br />4, FEE SCHEDIJI~E (Oam. glele iuad enter total M Al below) <br /> <br />A. <br /> <br />Limited Enecgy ~,~ $20,~ <br /> <br /> 401 amp~ ta 600 anlg~ <br /> <br /> a) The fee lbr brancb ¢ircuitq ~i!ll <br /> p~ of se~iee of fe¢~er fee <br /> ~gh bran~ cireuil ~ ~ <br /> b) ~le fee ilar branch eimults ~ <br /> <br />E. Miseellan~us (~rviee ~ F~er N~ Inelod~) <br /> <br /> PaCk nf 10 label~ ~ $3,~ each <br /> <br />H, Otb~ <br /> (~ rcquil'cd by ~tdldi~ oa}ciM) <br /> <br />$35.00 2 <br />$40.0O 2 <br />$80.00 2 <br /> <br />$35,00 <br />$ ZOO <br /> <br />$40,1x) --._ 2 <br /> <br /> $35100 __.__ <br />~ $50,00 <br /> <br /># of Labels N/~_ <br /> <br /> (,Bec. 3), if required <br /> <br />D, Rc. inSl)egtJon Fcc ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ IlO.pO <br /> <br />$. <br />$ <br /> <br /> <br />