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~MARION COUNTY <br /> ~[~i~ I~[~,~IVIS I0 N <br /> I_UJ~i~_CJv/g~i~! ' su~T~ c <br />FOR CITY VALIDATION <br /> '~'~ AUG - 6~997,'~ <br /> <br /> BUILg~NB ~SPEOTION <br />ELEOTRICAL PERM~ APPLIOA~ON <br />Ple~e complete ~1 ~ons, ~ through 5 ~ <br /> <br />1. LOCATION OF INSTALLAIlON <br /> <br />Job ~ipdon: ALA~ <br /> <br />PERM1T$ APE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STAKT[~ ~ IK) DAYS OF ISSUANC~ OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A~ CONTRACTOR IN~T3~LLATION ONLY <br /> <br />Elee~ealContractor BRTNKR HOME SECURITY <br /> <br />Address 8059 S.W. Cirrus Dr. <br />Phoneg (503) 641-0574 , { <br /> <br />ConUac~ I3c~m~ No. 34166cle , <br /> <br />2B. FOR OWl, lk[K INSTALLATIONS <br /> <br />ProperiyOvmer~pri, at) <br /> <br />Iv~iling ~dclr~ ] Pl~o¢ <br /> <br />Date: <br /> <br />Issued by: <br /> <br />5. FEES <br />A I. Enter total of fee~ from S~c. <br />A2. Add 5% $~h~c (.05 X Al) S <br /> <br /> ~ B. ~25%of~AI for P~ew <br /> <br /> D. Rc~pec~h~'~5.~) <br /> <br /> ~T~O~ D~ <br /> ~cipt No. <br /> <br /> <br />