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FOR CITY !~ ONLY <br />Received By: Date: <br />Zoning ny: City: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please com~let~ all Sertlons, I through $ <br /> <br />1, LOCATION OF INSTAI~ATION <br /> <br /> $itc Addr~ss: 12291 Dieckman Lane SE <br /> <br />John Weeks <br /> <br />97383 <br /> <br />p~one: (503) 393-8112 <br /> <br />Cr~ss Sm~EDirections: Off Staytolq Rd. <br /> <br />Project Descdl~io.: IrrigatiOn pump se~ce uPgra~re' <br /> <br />[PEP, MIT~ ARE NON. TRANSFER/dILE AND EJ~'IRE IF WOi~ <br /> NOT STAa~TED WITFIIN 180 DAYS OF ISSIJANCE OR IF <br /> WORI~ 15 SU.~PENDED FOR 180 DAYS. <br /> <br />2n. co~rmnca~o~ <br /> co.~=tor: GREMCO, Inc. <br /> <br />t~.ailiag ^~: P.O. BOX 9279 <br /> <br />C~: Brooks State: OR zip: 97305 <br /> <br />Pt~o.~: (503) 393-3553 <br /> <br />~: (503) 393-7604 <br /> <br />Colltracto~s l~loard No.: 39754 <br />C0~to~ U~.~: No.: 24-13C <br /> <br />FOR OWNER INSTALLATION <br /> <br />Ptopm~y Owner:. (pleaxe prO, t) <br /> <br />City: Sm~: Zip: <br /> <br />I am the PROPER13' OWNER and om~ r~side, i~ or <br />the co~plet~l ~ttucture and wilt be my own general contractor. 1 <br /> <br />struaur~ tr a~d or offered for ~ale before or upon compledor~ <br />him subcontractors, I will kir~ o~ty sa~omractor~ registered v~th <br />the Co~ C~ntraators Board If I change my rn~nd and do <br />hire a genrad contractor who is registered with the Construction <br />Contractort ~ard I will ~te~y noisy Marion County of the <br />name of the contractor <br /> <br /> PLAN REVIEW S~ECYION <br />IMmlo~ County does nat mliMlan~4an review. We wUI pm~de ~ <br />~ ~ if y~ ~ ~on ~ ~d submit mo (2) ~s ~ <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305 <br />8:00am - 4:30pm 24 HR Inspection Line 373-4427 FAX 588-794g <br /> <br />4. FF_dg SCHEDULE (eoml~e mM e~er totalin Al) <br /> <br /> Number of Inspections ~r ~ a]io*~ -- <br />A. Residential Per Om~ $erviee Inelnds~b <br /> <br />1000 sq. ft. ~ less <br />E~h additional 500 sq. ft. or portion fl~eof -- <br />Limlmd En~q~y <br />t=zc'n Manuf-a~'mt~d P..ome or <br /> NIodular Dweliin~ S~ric~ o~ Feed~ <br /> <br />Cost (escl0 Stun <br />x $110.~0 = $ 4 <br />x $20.00=$ <br />x $~0~0 = $ I <br /> <br />$52-00 = $ 2 <br /> <br />Al. Enter total of fees from Sec. <br />A2. Add State ~:,barge (.05% x A 1 ) <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ 55.00 <br />$ 2.75 <br />$ 57.75 <br /> <br />$__ <br /> <br />$__ <br /> <br /> <br />