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FOR CITY USE ONLY Received By: __ Date: Zoning By: City: Receipt #: Amount: $__ ELECTRICAL PERMIT APPLICATION Please complete all Sections, 1 through 5 1. LOCATION OF INSTALLATION Parcel ID: Parcel Owner: Phone: Cross Street/Directions: Project De~ciption: PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. City- State. tg:9~e_ Zip' a~ ~, lB. FOR OWNER INSTALLATION Progeny Owner: (please print) Mailing Address: City: State: Zip: I am the PROPERTY OWNER and ow~, reside in, or will reside in the completed structure and will be my own general contractor. I understand that I must register as a conztruction contractor ~f the structure is sold or offered for sale before or upon completior~ If I hire subcontractors, I will hire only subcontractors reg~tered with the Construction Contractors Board. lf l change my mind and do hire a general contractor who is registered with the Construction Contractors Board, I will immediately nattfy Marion County of the 3. PLAN REVIEW SECTION n SB and submit two (2) sets of[ MC 15-34 Rev 9/98 MARION COUNTY BUILDING INSPECTION 3150 Lancaster Dr. I~E - Suite C Salem, Oregon 97305 8:00am - 4:30pm 24 HR Inspection L'me 3734427 FAX 588-7948 Number of InsI~cfions t~r permit allowed One~T~ Family Dwdlk~ Fee: ~q, Feet x $ .09=$ S. FEES Al. Enter totsl of fees from Sec. g4 A2. Add State Surcharge (.05% x Al) SUBTOTAL B. Enter 30% of line A1 for Plan Review C. Investigation Fee (if required) D. Reinspection Fee ($50.00) E. Additional Plan Review ($62.50/hr, minimum one-half hour) E Insgection for which no fee is specifically indica*~l, ($62.50ihr, minimum one hou0 G. Inspec~on Outside Normal Business Hours, ($62.50/hr, minimum two hours) H. Indus~ial Plant ($62.50/bx) TOTAL AMOUNT DUE $ $ $ $ $