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I OR CITY VALIDATION1 <br /> e~eived by: _ <br /> <br /> MARION COUNTY <br />':BUILDING INSPECTION DIVISION <br />3150 LANCASTER DR NE - SUITE C <br />SALEM OREGON 97305-1398 <br /> <br /> 24 hr. L~spection Line 373-4427 <br />Office: Phone 588-51;~? ;8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />Date: : <br />Issuod by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />P/ease complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />2A. COI~Ti'RACTOR INSTALLATION ONLY <br /> <br />ElectricalContractor ~L{ ~NJO <br /> <br />2.B. FOR O~ INSTALLATIONS <br />Prepay Owner (ple~ta pri~) <br /> <br />Mailiug Addresa _ i ~ <br /> <br />City/Stata/Zip <br /> <br />:3. PLAN RBVIHW.SBCTION <br /> <br />Marion'CoUaty does not require a plan review <br />We will 0rovide'plan review se~ice if you complete <br />~eefion-~B and subl~it two (2) sets of plans and <br />~ifi~tioas'witti/his application <br /> <br />4. FB~ SCIdiiDUL~ (C~mplete and eater total {~ A 1 below) <br />~ch ad~fio~ ~ sq. f[ <br /> <br />a) Th* f~e for b/aaeh ciceuit~ ~ <br /> <br />/ <br /> s o.oo2 <br /> <br />$35.00 2 <br />$40.00 2 <br />$80.00 2 <br /> <br />szoo <br /> <br />$35.~ <br />$2.~ <br /> <br /> Al. Eater Iotal off¢~ from $~. g4 $ 50 <br /> ,3.2. Add 5% at'chat'ge (.05 x Al) <br /> S~btotal <br />· ~. '-,. , [ I <br /> <br />/~.: (s~2s~ir~ - ~_~ <br /> <br /> <br />