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.... ".r. ' ............................ MARION COUNTY BUILDING INSPECTION <br /> FOR O.T¥ USE ONLY 3150 Lanc. mter Dr. NE - Suite C <br />Rcceiv,-a By: Dat~: Salem, Oregon 97305 <br />!Zonia-B~ ~. ...: · I ~?,: ::,', : 800am::~0pm ,~L~2~'I-~p~donLi~373-4427 FAX588-7948 <br /> <br /> MARION COUNTY <br />I ELEL-I'R[CAL PE]L~ APPLICATIO~UILD[NG INSPECTIO - Nla eroflml ° Pm'Pm'mk ll°we <br /> Pl~a~ campier all Sections; I through $- I - - : <br /> ! <br /> <br /> L LOCATION OF H4b-1'ALLATION ........... .Eac. h addifi~1500 sq.'9~ c~ portion ~o f x $20.00=$ <br /> Parc~! I~: Limited ffa~gy x $30.00 = $ <br /> <br />PKR, MI'I~ ~ NON. TP-utN,~FERA~I,E AND ~I~ IF WO~ <br />1~ N~ ~ wlI'~l~ 180 ~ 0~155~ OR I~ <br />WO~'I$'S~ FOR 1~ DA~ ' <br /> <br />~ CO~R ~N ~ <br /> <br /> C~PORTLA~" ELECTR~CA~ C0~ST. <br /> ~.m.~n~ 1019 7th Streeet <br /> <br /> ~OREGON CIT~ s~OR ~:97045 <br /> ~' (503)655-2281 <br /> F~: (~503) 655-5033 <br /> <br /> ~~No.: 3-246C <br /> <br /> Ci~: S~ <br /> <br /> ~ i~ fOM or offered for ~ ~o~ or u~ ~ Iff <br /> C~ ~ 1 will ~ely ~ M~ ~ ~ ~ <br /> <br /> 3. P~ ~W SE~ON <br /> M~ ~ ~s n~ ~u~ a ~ ~ew. We ~l ~ pl~ [ <br />mv~ ~c~ if you c~ Sm~ $B ~ suer ~o (2) ~ of [ <br /> pl~ ~ s~c~o~ wi~ ~ a~li~. . [ <br /> <br />x <br />x. $80,00=$ <br />x $130.00=$ <br />x $170.00 = $ <br /> <br />x ~55.00 = $ <br /> <br />SUBTOTAL <br /> <br />Al. En~' total off~a from S~c~ #4 <br />A2. Add Sram SureJmr~ (.0~ x Al ) <br /> <br />TOTAL AMOUNT DUE <br /> <br />$__ <br />$__ <br />$ <br /> <br />MC 15-34 Rev 9/98 <br /> <br /> <br />