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FORCrl'YUS£ONLY { {~;~] -fir '/ <br /> <br />............ X ....................... ~ MARION <br />ELE~CAL PEr'APPLICATION { BUILDIH6 <br /> <br /> 2~ CO~OR ~FO~ATION <br />~ C~: ~ ' S ~'~C ~. ~C. <br /> <br /> Cigna~ Sine: OR Zip: 97383 <br /> <br /> ~ 1-503-769r71 ~4 <br /> <br /> C~S~dNo: 443~4 <br /> <br /> C~a~ Li~ No: 24-365C <br /> <br />Supcw,so~ Lice~s~ No: 1 336S <br /> <br />IE ~R Q~ER ~TION <br /> <br /> Cib: Sate: Zip: <br /> <br /> ~uaure i~ ~oM or offered for ~le before or upon comple~on, <br /> Conduction Con~actort Board. Ill change my mind and do hire a <br /> Con~actor~ B~. I will immediately not~ Morton Coun~ of the <br /> <br />O'.,me~'s Signatu~: <br /> <br />PLAN REVIEW $£CTION <br />Marie~Countydo~snO~requireaplanreview. We will lwovidcI <br />plaen review service if you complcm¢ Section 5B and submi! two (2) <br />se~ of plans and ~eifleati~.~ wilh thi~ app,licafion. , <br /> <br />it. Residential Per Unit, ~n'ice Included <br /> Imr~ Co~ (each) Sum ~ <br />t~ St. ~.~ ~ I x SI t0.~=' <br />~ki~lS~.F~i~f ~ x S20.~-S~ <br />L~ E~ x $ 30.~ - S I <br /> <br /> M~uI~II~F~ x $52.~ - $ , 2 <br /> <br />~ ~1~. or Feede~ ~ not Inel~ branch O~ul~ ~e ~on D} <br /> <br />2~ x $65.~ - $ 2 <br />201 ~4~ x S80.~ - $ 2 <br />401~ x S130.~- S~ <br /> <br />~ 1~ x $3~.~= $ 2 <br />~ Tem~m~ ~iee~eede~ <br /> <br />201 <br /> <br />D. Broach O~ul~ <br /> <br /> a)~ ~~em~ <br /> ~ ~ F~ F~ ~ Br Ck <br /> b)~c~t~ <br /> <br /> F~ B~ C~ <br /> ~ ~1 B~ C~ <br /> <br />Si~ C~i~a) <br /> <br /> (~~~) <br /> <br />Dwelling Permit Labels (For Single Family I)w~lllngs Only) <br /> <br />OTHER, u required by the Balldlng Official <br /> <br />TOTAL <br /> <br />x $4f00 = S .,, 2 <br />x $ $5.00 - S 2 <br /> <br />x $ 3.00 - $ ,,, <br /> <br />x $ $0.00 - $ <br />x S <br /> <br />x $ 55,00 = S 2 <br />x $ 55,00 = $ 2 <br /> <br />x $ 55,00- $ , 2 <br />x $ 50.00- $ <br />x <br /> <br />x <br />x $ .09 -$ <br /> <br />5. FEES <br />Al. EnterTolal Feusfi'om Section #4 <br />A2 Add Stat~ Sumha.,'g~ (.05% x Al) <br /> <br />SUBTOTAL: <br /> <br />B. Ente~30%oflineAI forPlan R~view <br />C. Investigation F~e, if,,:qui~l <br />D. Reins~ecfion Fee ($50.00) <br />E. Additional Plan Review (62.50/hr. <br />minimum one-half hour) S <br />F. inspection for which no fee is sl~cifieally indi~ <br />(S62.50A~, minimum one hour) S ~ <br />O. inspection Omsid~ Nomud Business Hours, <br />$62.50/in', minimum two hours) $ ~ <br />H. industrial Plant ($62.50/hour) TOTAL AMOU]qT DUE $ [ ~'--7 ~ <br /> <br />MC 15-34 Rev 9/98 <br /> <br /> <br />