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FOR CITY <br />R~eived by: <br />Date: <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> COMMUI~I~_~OPMENT CENTER <br /> <br />IC~ ~A¥ I R4qq_tiPP <br /> '"' Offl~: P'~'o~] 588-5147 8:Ham - 4:{0pm <br /> tax: sBs-?9,m tssued by: <br /> <br /> '~ G$' NTY <br />I ELECTRICAL PERMIT APPU~NS~CTi0N <br /> Please complete all Sections,~'tEr-dd~h $ ! <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />pF~RMITS ARE NON-TRANSI~IABLE AND EXPIRE IF WORK I$ NOT <br />STARTS) WITmN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR O]{tKi~}~, II~ALLA~IOI~[ <br />P~op~r~l Own~c (ple~ prir~) <br /> <br />lvlniling Address J Phone <br />O~n~Fn Signatm'e: <br /> <br />3. PLANRBVIEW 811CTION <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 15-341/96 <br /> <br />q-/- OI ado b <br /> <br />5. i~ES At. Eme~ Iotal of fees from $e¢. #4 <br /> A2. Add 5% sur~hsr~ (.05 x Al) <br /> <br />~b~a{ <br /> <br />B. Enter 2.5% of lineAl forPlanRev'tew <br /> ~ec. 3), if required <br />C. Inve~6Satiou F~ (il' tequltod) <br />D, Reimpe~tion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUg <br /> Roceipt No. <br /> <br />$35,00 <br />$ 2.00 <br /> <br />$35.00 <br /> <br />sq. fi, x $.0~8 = <br /> N/C <br /> <br /> <br />