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FOR CITY YALI1)ATION[ <br />])ate: <br /> <br />MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 LANCASTER DR NE - SUITE C <br />SALEM OREGON 97305-1398 <br /> <br />Office: Phone 588-S1~7 ,.8:00m * 4:30pm <br />FAX: 5887948 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />P/ease complete all ~ectlons, I through 5 <br /> <br />~OCATION OF INSTALLATION <br /> <br />lob Add~s <br /> <br />ci~ <br /> <br />Job Dcscri~dom <br /> <br />PF. RMrrs APE NON-TP, A.NS~LIg AND EXPII~E IF WORK IS NOT <br />STARTED wrrH~l 180 DAYS OF ISSUANC~ ORIF~ <br /> WORK IS SUS~ED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />.~ddrc~ <br /> <br />PropcrtyOwacr 97'0~ / 2 ~ <br />Cec. uacto, L~ No. PO3:]8 <br /> <br /> Siguaum of Sup~rvisiu~ Ek~Ukian <br /> <br />~ 2~.~OR OWNItRIN~TALLATION8 <br /> <br />Prop~y Ov~er (pl~pri~) <br /> <br />c~/s,=,r~ .~ur o ~ A - O TC, <br /> <br /> 3: .PLAN~PLHVIHW SECTION <br /> <br />|We wil!./~rovidcpl~, revi~w se~iC~ ifyou COmplete <br />{.i~tio_n!5,B aud s. ubn~t two (2) setsof plans'and <br />[ ~ificati°ns:wllfi{hib'aPPlicafion. . ' <br />: MC 15-$4 I/~6 ~ <br /> <br /> <br />