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BUILDING INSPECTION DMSION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Inspection Line 373-4427 <br />Office: phone 588-5147 S:00am - 4:30pm <br />FAX 588-7948 <br /> <br />IELECTRICAL PERMIT APPLICATION I <br />Please complete all Sections, 1 through 5 <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 1 g0 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OllqqER INSTALLATIONS <br /> <br /> Property Owner (pleo~e prinO <br /> <br /> Mailing Address <br /> <br /> City, State, Zip <br /> <br /> Owner's Signature <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion County does not require a plan review. <br /> We will provide plan review service if you complete <br /> Section 5B and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in A1 below) <br /> <br />5. FEES <br />Al. Enter ~tal of fe~ fro~ See. #4 $ <br />32. Add 5¥* surcharge (.05 xAI) $ <br /> <br />Receip~ No. <br /> <br />MC 15-$4 7/97 <br /> <br /> <br />