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FOR CITY VALIDATION <br />Received By: <br /> <br />Date: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />IPERMITS ARE NON-TRANSFERABLE AND EXPIRE 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 />Property Owner (pleoze print) <br /> <br />Mailing Address <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 />I We will provide plan review service if you complete <br />I Section 5B and submit two,(2) sets of plans and <br />I specifications with this appdcation. <br /> <br />MC 15-34 7/97 <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR ][nspeeflon Line 3734427 <br /> Office: phone S88-$147 8:00am - 4:30pm <br /> <br /> I <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al below) <br /> <br />panel, alteration or exten~on I S40.00 ~-- O2 <br /> <br />sq. fl. x $.068 =__ <br /> <br />5. FEES <br /> Al. Ent~' total of fees from Sec. <br /> Al. Add 5% surcharge (.05 x Al) <br /> <br />B. Enter 25% of line A 1 for Hah Review <br /> (See. 3), if required <br />C. Investigation Fee (if reqalr~d) <br />D. Reimpection Fee ($25.00) <br /> <br />Receipt No. <br /> <br />Subtotal <br /> <br />TOTAL AMOUNT DUE <br /> <br />s qo. oo <br />$ ~.00 <br /> <br /> <br />