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FOR CITY VALIDATION BUILDING INSPECTION DIVISION · <br /> <br /> 3150 LancaSter Dr. NE - Suite C <br />Received By: _ __ Salem. O~egon 97305-1398 Date:__ <br /> <br /> ELECTR GAL PERM T APPLICATION I~:~ ~" ~f <br /> I t~*,~,O 4. FEE SC[~DULE (Comp ere ~nd enter total ~ <br /> <br />wh21553 Liberty Street <br /> <br /> urora <br /> Aurora Presbyterian Church <br /> <br />CROSS STREET/ <br />DIRECTIONS / <br />PROIECTDESCRWIIONDrop ceiling lights in basement <br /> <br />PERMITS ARE NON-TRANSPERABLE AND ~XPIRE IF WORK IS NOT I <br /> I <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />F~ctricalContracmr Dryden El~gtri¢, Inc, <br />Mailing Address PO BOX 266 City Hubbard <br /> <br />~hone 5 0 3 -- 9 g 1 -'13 9 1 3 <br /> I <br /> <br />~s Lice~m NO. 2 4 -- 3 2 2 C <br />Con~tocB~RegNo, 0 0 9 8 9 4 3 <br />s~i~r Li~ 3_ I 1 3 8 S <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Proger~ Owner (please print) <br /> <br /> Mailing Address <br /> <br />City, Smt~, 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 appdcation. <br /> <br />First branch circuit 1 $35.00 ~5. O0 <br /> <br />5. FEES <br />AL ~.ter tota~ of f=s fr~m S~. ~ S 37.00 <br />A2. Add 5% surcharge (.O5 x A l) $ 1.85 <br /> <br />B. Enter 25% of line Al for Plan Review <br /> (See. 3), ff required <br />C. luvestig~ion F~ (if required) <br />D. Reinspection Fee ($25.00) <br /> <br />Receipt No. <br /> <br />38.85 <br /> <br />TOTAL AMOUNT DUE <br /> <br />s 38_R~ <br /> <br />MC15-347~7 <br /> <br /> <br />