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FOR CITY VALIDATION <br />Received By: <br /> <br />Dale: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DMSION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, O~cgon 97305-1398 <br /> <br /> 24 HR Inspe~tion Line 373-4427 <br /> Office: phone 588.5147 $:00am - 4:30pm <br /> FAX 588.7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />pF_gMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <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 />Mailing Address City <br /> <br />Phone I ~" m <br />IAX ~ m <br />Contractor Board Reg No. <br /> <br />2B. FOR OWNER INSTALLATIONS <br />PropertyOwner(pleaseprint)~/ ~C~,~..~ <br /> Mailing Address "~t0 ~' t~l~ff'~'--~.~ ~ F~ <br /> <br />SM~on County does not ~quim a plan review. <br /> We will provide pl~ ~view se~ice if you complete <br /> S~fion 5B ~d submit two (2) sets of plus and <br /> s~ificafions wi~ ~is app~cadon. <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete aad e~m total i~ Al below) <br /> Number of lmp~ctlons p~r ~t ~ <br /> <br />sq. ftx $.068 =__ <br /> <br />N/C <br /> <br />5. FEES <br /> Al, Enter total of fe~s from Sec. <br /> A2..Add 5% surcharge (.05 x Al) <br /> <br />B. Enter 25% of llne Al for Plan Review <br /> (See. 3), if required <br />C. Investigation Fee (if required) <br />D, Reinspection Fee ($25.00) <br /> <br />R~ceipt No. <br /> <br />Subtotal <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br />$ <br />$ <br /> <br />MC 15-34 7/97 <br /> <br /> <br />