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FOR CITY VAI.mATION[ <br /> <br />Date: <br /> <br /> MARION COUNTY <br />!BUILDING INSPECTION DIVISION <br />3150 LANCASTER DR NE - SUITE C <br />SALEM OREGON 97305-1398 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />P/ease complete.all ~ections, I through <br /> <br />OI11¢~: Pl~;ae ~8-~l~7.::8:00am-4:30pm <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Job ^dd~ <br /> <br />pE, p~Mi, TS A R,E N. ON..~ .T~., N,. SFERA~LE AND EXPii~.E iF WOiC~ iS NOT <br /> STARTE~ Wi i]~BI~ 180 DAYS OF LssuANcE OR WORK IS $USPEi~DED FOR 180 DAYS. <br /> <br />No. <br /> <br />! <br /> <br />Phone~ <br /> <br />2B. FOR OWNER ]NST3T.T A.TIONS <br /> <br />Mailing Add.ss I Pho~ <br />City/S~e/Zip <br />Owne, r'~ $i~namr~: <br /> <br />IM-Zdon':~unt~:~!~:n~t:t~luim a plan review. <br /> We w~i~t0vid~!~:revi~ ~ if you ~0mplete <br />.,$?i0nsB.and ~ubniit two (2) sets of plato and <br /> <br />MC 15-~41/96 <br /> <br />...qT- o5a7 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />2 <br /> <br />2 <br />2 <br />2 <br /> <br />N/C <br /> <br /> <br />