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[F(~R~ VALmATIONI <br />Received By: ~ <br /> <br /> Date: , <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Lancaster Dr. NE - Suite C <br /> Salem, O~gon 97305-1398 <br /> <br /> 24 HR Insp~ton L~e 373-4427 <br /> FAX <br /> <br />IELECTRICAL PERMIT APPLICATION <br />P/ease complete afl Sections, I throu~ 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> ~o~ss 7~7~ 5h0~ctrL4~. <br /> <br />I ~ ~ NON-~S~ A~ ~ ~ WO~ = NOT <br /> ST~ ~ 1~ DAYS OF ISSU~ OR ~ <br /> WO~ IS SUSP~ FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALlaTION ONLY <br /> <br />Mailing Addr~s City <br /> <br />FAX [ ~ --- <br /> <br />Contractors License No. '' C <br />Conlractor Board Reg No. <br />Supervisor License S <br />Sigm~um of Supv. El~tri~mu <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />L 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 />A. Reside*AiM Per Unit <br /> <br />Un~d Enemy <br />Each Manufacm~d Home or <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complet~ md ~ total in At <br /> <br /> $85.~ 4 <br /> Sl5.~ . <br /> <br />A2. Add 5% surcharge (.05 x Al) <br /> <br />Subto~l <br /> <br />B. Enter 25% of line Al for Plan Review <br />(See. 3), if req~i~d $ <br />C. Inv~figafi~ F~e (ff r~quired) $ <br />D. Re~ ~ (~5.~) $ <br /> <br />MC15-347/97 <br /> <br /> <br />