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{ ,I~OR OFFICE USE ONLY { <br />Received by: 220 High Street <br /> Phone 588-5147 8:00 mu. 4:30pm <br />II ~ i "7 -- ~ ~ {,~Oxl~.A4'h~ ~8-?'~4 ~'ITE '~' Permi~ No. <br /> <br /> 1. LOCATION OF INSTALLATION <br /> <br /> "-' <br /> <br />J~Add~'20256 Grim Road NE <br /> Aurora {cro.~ Boones Ferry Road <br />Dh~, Behind NorthMarion Middle School <br /> <br /> Wire for mobile classroom <br /> <br />PER/VI1TS ARB NON-TRANSFB~AB~E AND NON-REFUNDABLB AND <br />EXPIKE IF WORK IS NOT STARTED W1THIN 180 DAY~ OF ]SSUANCR <br />OR IF WORK IS SUSPI{NDBD FOR 180 DAYS. <br /> <br />2A. CONTRACTOR ~I'ALLATION ONLY <br /> <br />E~c~m~°'Drvden Electric Incl~"""e 981-3913 <br />Ma~ugA~'po Box 266. HubbardOR 97032 <br /> <br /> 678-58_35 <br /> <br />O~NO' <br /> <br />2B. FOR OWNER INSTALLAT{ONS <br /> <br />City/Stat-dZip <br /> <br />T{~ imudhdcm is bei~ made ,mm !xopegy I own which is not intender fo~ #lc, <br /> <br />3. PLAN REVIEW S~-'TION <br /> <br />We will provide phm review servi~ if yo~ complete Section <br />5B and submit two (2) s~aof plums and sl:x~ificad(:ms wilh <br />this applic,~ion. <br /> <br />This optional pl~ r~vicw program does not Suslxmd the <br />mcluimd submission of lighting power calo,lntions, plans. <br />and specifi~allons when required by thc Oregon Sa'uc, agal <br />Specialty Co~, Chap~ 53, <br /> <br />MC 15-341119] <br /> <br />1000 sq. ~ m-less <br /> <br />$15.00 <br />$20.00 1 <br /> <br />$40.00 2 <br /> <br />$2.00 <br /> <br />q5,00 <br /> 2.00 <br /> <br />$40.00, 2 <br />$40.00 2 <br /> <br />$40.00 <br /> <br />~5.00 <br /> <br />$50.00 <br /> <br />5. FEJ~ <br /> Al. Entre' total of fees from Sec. #4 <br /> A2. Add 5'~ m.c~ar~ (.05 xA1) <br /> <br /> B. Enter 25% of tine Al for Plan Rewew <br /> <br /> TOTAL AMOUNT DUll <br /> <br /> l~ila No, , <br /> <br />slOO.OO <br />$ <br /> <br />$105. O0 <br /> <br />$ <br />$ <br />$ <br />$105. O0 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> <br />