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MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 LANCASTER DR NE - SUITE C <br /> <br />FOR CITY V/LI.,IDATION[ SALEM OREGON 97305-1398 <br /> <br />Received by: , [ <br />Date: I 2,4 hr. Imp~flon Line ~73-~27 <br /> <br />ELECTRICAL PERMIT APPLIOATI~ <br />Please complete all 8ectlorts, I tl~rod~b~ ~U$ - ? <br /> <br />1. LOCATION OF IN~TALLATI~~T'/g ~A[:{ION COL <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />I <br /> <br />P~ A~ NON-~~ ~W~ ~ N~ <br /> ~ ~ l~ DAYS O~ ~SO~ ~ ~ <br /> WO~ {S SUS~ ~R 1 ~DAYS. <br /> <br /> ~. CO~CTOR ~TION O~Y <br /> <br />Pa~in El~c, Inc, 202~ S Molalla Ave. <br />Or.on Ci~, 0R 97045 ~57-~58 fax: 557-1059 <br />Contmcto~ Lic~e~: ~ ew. 10-01-97 <br />Su~sor: 4241~ e~. 10-01-98 <br />Contractom ~ard R~ ~: 35151 e~. 1~d2-98 <br />M~m ~ 2416 exp. 11-01-97 <br /> <br /> SiCm~r¢ ot Su~ EI~c~ <br /> Su~rv~rq ~c~ No, W~ <br /> <br />2B. FOR OWNI~ ]lqSTALLATION$ <br /> <br />Properly Owner ~le4t~pri~) <br /> <br />Mailing Addrgas J ~ <br /> <br />Cily/StateffZip <br /> <br />3. PL~Jq RBV~t~i~ S]~CTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complet~ <br />Sect/on 5B and subn~'t two (2) sets of plans and <br />specifications with this application. <br /> <br />MC 15-34 1/96 <br /> <br />B. ~ ~ Foeders (Does ~ot i~¢lud~ ~ ¢il~,ui~, see section D) <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br /> .~q.d"t. x $.068 <br />it df <br /> <br />$35.0~ -- 2 <br />$40.00' 2 <br />$80.00 2 <br /> <br />$ ZOO <br /> <br />$35,00 <br />$ 2.00 <br /> <br />$40.00 <br />$4O.OO <br /> <br />$4O.OO 2 <br /> <br />FEES <br />Al. Enter total of feea from Se~. ~4 <br />A2. Add 5% ~uroharge (.05 x Al) <br /> <br />s \-I(n ,qo <br /> <br /> pm Issued by: <br />-ju$ ' <br />i~['~ ~"~"~CM H~'~ (~ompl~¢ ~ient~ ~Hn Al below) <br /> <br /> <br />