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FOR CITY VALIDATION[ <br />Received by: { <br />Date:. { <br /> <br /> Date: <br />F~: 5gg-~94g I~ <br /> <br />iELECTRICAL PERMIT APPLICATION <br />P/ease complete all Sections, 1 throug# 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> PEEMITS ARE NON,TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTEO WI'I'IUN 1~0 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR IS0 DAYS, <br /> <br /> CONTRACTOR 5JNSTALLATION Olq~Y <br /> <br /> ;~2~/'_~.~da'~ _.~ ~ _~z_~ ~~. ~ <br />,??.~27~,,~ . ..q~.. ~4o~ ~z~_b ~g- /~/ <br /> <br /> Signamru ol'Supe~i~i*lg Elcgtrlci~ ~~~~ <br /> <br />2B, FOR OW~fBR INSTALLATIONS <br />I~x~pet~y Ow~ler ~lc~$O prinO <br /> <br />City/State/Zip <br /> <br />PLAN'REVIEW SECTION <br /> <br />Marion County does not rexluire a plan review, <br />We will provide plan review service if you complete <br />Section 513 and submit two (2) sets of plans and <br />specifieatiens with this application, <br /> <br />MC 15-34 12/94 <br /> <br />4, FEE $CFItitDLrLE (Complot¢ and enter ultal in A 1 below) <br /> <br />200 aml~ or loss $50.00 <br />201 amp~ ~o 400 amps $60.00 <br /> <br /> ~imt branch cis~uil / $35.00 <br /> Each pmnp or irrigation eir~Ie ~ <br /> <br /> (~ ~quirea by B~ildiag <br /> <br />5. FEE8 <br /> <br /> A2. Add 5% s~rehm'ge (.05 x AD <br /> <br />B. Enter' 2.5 % of linc A 1 lbr Plan Review <br /> <br />C. hlwmigatkm Fo~ (if requited) <br />D, R¢irmpeetion Fe~ ($25,00 $,, <br /> <br /> TOTAL AMOUNT DUE $ /(Z2 ~jC <br /> <br /> <br />