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FOR CITY VALmATIONI <br />Rc~eivecl by:... <br />Datc: . <br /> <br /> MARION COUNTY <br />~ BUILDING INSPECTION DIVISION <br />3150 LANCASTER DR NE ~ SUITE C <br />SALEM OREGON 97305-1398 <br /> <br /> 24 Im Impec~owI2ne 373-4427 <br />Office: Phone 588-~147,,8:00~u - 4:30pm <br />F~: ~88-7~18 <br /> <br />(~. ~cATELECTRICAL PERMIT APPLICATION <br /> e completeall Sections, I through <br /> <br /> ION OF INSTALLATION <br /> <br />Prope~y Owner <br /> <br />ContraCrtOrs License No. <br /> <br />lob No. <br /> <br />Supervisor's License No. j Phon~ J <br /> <br />~'~ FOR OWNER IN~I'ALLATIONS <br /> <br /> 3. PLANR~VHIW SECTION <br /> <br />I mrioa:~untytlo~snot.'require ,a.~m review. <br /> we wili~Pr°vide'Plin review ser~ if you Complete <br /> <br />s~in~tiOns:With fl;i~ ~pi~licafi6n. ~' <br /> <br />MC ~5-.~4 1/96 <br /> <br />PERMff NO ~ <br /> <br />Date: - <br /> <br />Issued by: <br /> <br />Al. Eater ~oml of fees f~m Sec. ~4 <br />A2. Add 5% surcharge (.05 x Al) <br /> <br />~btotal <br /> <br /> TOT~& AMOUNT DU'~ <br />.., R~cip! No. ' · . ' <br /> <br /> <br />