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MARION COUNTY <br />BUILDING INSPECTION DIVISION <br /> 3150 La~ D~. NE- Sultc C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Inspection Une 37~4427 <br /> Of F~'~e: phone S88-$147 8.'~Oam. 4:30pm <br /> FAX 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />L LOCATION OF INSTALLATION <br /> <br /> PROPERTY OWNER ~ ~-~ ~ L,~ <br /> D~ONS <br /> <br /> PRO/ECTDESC~/PTION ~_00~ 5ec'~ct._. <br /> <br />2A. CONTEACTOR LNSTALLAT[ON ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Property Owner (please print/ <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 SB and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC 15.]4 7'97 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (¢o,,,~ ,,,d ~ter,~t in ^l ~low) <br /> <br /> I <br /> <br />200 ataps o~ less ~ S50.00 .~.L~_ 2 <br /> <br />5. FEES <br /> A I Enter iotal of fees from Sec a4 $ ,.~('"~ , ~ <br /> <br />Rcccip{ No.__ <br /> <br /> <br />