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FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <br />MARION CO~ BUILDING INSPRCTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church 5t NE. Room 132 PERMff NO: <br /> <br /> FAX: 588-7948 Issued by: <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I throu~l; <br /> <br />Directiom <br /> <br />PERMITS ARE NON-TRANSFERABLE AND ~ IF WORK I8 NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />r~ec~calC°"~e~CHERRY CITY I ~°3997609 <br /> ELECTRIC <br />MnilingAddt~, P0B 12668, Salem <br /> <br />2B. FOR OWNI~ INSTALLATIONS <br />Pmperq, Owner (ptea~ print) <br /> <br />Mailing Addreas [ Phone <br />City/Slate/Zip <br />Ow~.ee'a Signature: <br /> <br />3. PLAN RBVIEW SECTION <br /> <br /> Marion County does not require a plan review. <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 />MC 15.34 1/96 <br /> <br />la~t~H~tioa, AIt~ation ~r <br />200 ~ or 1~ $~ 2 <br />201 ~ to ~ ~ ~ . 2 <br />~1 ~to~am~ $1~.~ . 2 <br />~1 ~ to I~ ~ $1~.~ 2 <br />~r I~ ~ or vol~ ~.~ 2 <br /> <br />Temp~ary <br />In~a~t~, ~ati~ ~ R~t~ <br /> <br />~1 ~ to ~ ~ ~.~ 2 <br />~1 ~ to ~ m~ $~ 2 <br /> <br />~an~ <br />N~, ~t~at~ ~ E~ P~ Pa~ <br />a) ~ fee f~ b~h o~m ~ <br />. <br />~ch b~neh e~uit $ ~ <br /> <br />b) The ice for b~nch citvuils ~ <br /> <br />First branch circuit <br />Each ad~tional brmch ~ircuit <br /> <br />$3.5.0O <br />$ 2.OO <br /> <br />5. FEES At. Enter total of fees from Sec. S4 <br /> A2. Add 5% sut'charg~ 605 x A 1) <br /> <br />~bto~tl <br /> <br />B, Enter25% ofline Al fotPlanRevimv <br /> (Sec. 3), if requited <br />C. Investigation F~e (if required) <br />D, Reir~p~t'~a Fee (S25.0O) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br /> <br />