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MARION COUNTY BUILDING INSPECTIO!~ <br /> COMMUNITY DEVELOPMENT CENTER <br /> FO R C iT y.y~LitD~Ti ~)N] 285 Church St NE · Room 132 <br /> <br />Date: I . -, <br /> ofrw,~ 588-5147 8:00 a.m. - 4:30 p,m. <br /> FAX: 588-7948 <br />I ELECTR'CAL PERMIT APPUCATION I <br /> 1. LOCATION OF ~TION <br /> <br />Directions <br /> <br />Deacrlptioo <br /> <br />PERMrrs ARE NON-TRANSFERABLE AND EXPIRE IF WORK Is NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Mailing Address <br /> <br />Signat ute of Supervising Electrician <br /> <br /> 2B. FOR OWNER INSTALLATIONS <br /> <br /> Property Owner (please print) <br /> Mailing Address I <br /> City/State/Zip <br /> <br /> Owner's Signature: <br /> <br /> 3. PLAN RtlVIBW 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 12/94 <br /> <br />b) The foe for branch circuila without <br /> purchase of service or feeder <br />Rmt branch ¢i~uit <br />Each addhlonal branch circuit <br /> <br />$35.~ <br />$2.~__ <br /> <br />FEES <br />A 1. Enter total of t'e~ from Se~./~ $ ~,/ <br />A2. Add 5% surcharg~ (.05 x Al) $~ <br /> ~bto~al $.__ <br /> <br />B. Entar 25% of ]in~ A 1 for Pisn Review <br />(See. S), if required $.__ <br />C. Investigation Fee (if required) $.__ <br />D. Reinspection Fee ($25.00) $.__ <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br /> <br />