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Received By: <br /> <br /> MARION COUNTY <br />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 $88-~147 8:00am - 4:30pm <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> T~A~°~"°'I I I I I I--I 1~6i~'"~ <br /> ,o,n,~s 717'7 ...~,..,.,.-~,., ~ <br /> ~o~l I I 1-171~l~l-I~l~lolg ~ <br />D~ONS ~~_ ~ <br /> <br />PERMITS ARE NON-TRANSFERABLE AND ~ IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> ~ Owner (please print) <br /> <br /> Mailing Addreas <br /> <br /> Ci~, Slate, Zip <br /> <br /> Owner's Signature <br /> <br />Date: <br /> <br />Issued by: <br /> <br />35'- <br /> <br /> 2 <br /> <br />a) The fee for branch ci~ai~ v,t~ <br /> <br />Sigmd circak(s) ~ a limi~d ea=gy <br /> <br />3. PLAN REVIEW SECTION <br />IMarion County docs not require a plan review. <br /> We will provide plan review service ff you complete <br /> Section 5B and submit two,(2) sets of plans and <br /> specifications with this appdcafion. <br /> <br />MC 15-34 7/97 <br /> <br />B. Enter 25% of line A I for Plan R~view <br /> (Sec. 3), if required <br />C. Investigation Fm (if required) <br />D, Reimpection F~e (S25.~0) <br /> <br />Subtotal <br /> <br />TOTAL ~OUNT DUE <br /> <br /> <br />