HomeMy WebLinkAboutB1103-325 TEMP HEAT APPL.PDF(828)465-8399 Office Number P.O. Box 389
(828)465-8962 Fax Number UO(at-24-1 Newton, NO 28658
CATAWBA COUNTY APPLICATION FOR PERMIT
(COMMERCIAL ONLY) (Please print or type) \ / Date
--Temporary Electrical —,/—\Temporary Mechanical
> Building Permit No. (if Applicable)
,r,Property ID No, t Use of Structure— T-
�Physical Street Address_ f (C i n)
Owner 6 it 'I —
Telephone (i2 '-2K ( '41 24
L
Last First
owner's Address— IV 6- 0
City State Zip
'
Subcontractor �4, Qe4 - Prit+'111- -5�'f 04,1r Telephone
Listed in License Book)
Subcontractor Address ox 1,3 7et
City State Zip
State License No. & Classification 130Q(J
M
General Contractor— 4AE & l Telephone(01) 7Vl, 'WLA
—Location of, Structure or Project (Physical Directions, Road Numbers and Names, Etc.)_
This aareement between Catawba County and (Own(
or Authorized agent)authorizes temporary power/temporary mechanical service to be establish(
on the Building for above named project for a day period.
This agreement does not constitute a Final Inspection for Electrical Power/Mechanicz
Service. we further release Catawba County and its employees from any liability which me
arise from this agreement.
The parties acknowledge that occupancy of a building without a Certificate of Occupancy a I
a violation of local and State law and exposes the violator to criminal and civil sanctior
if occupancy occurs before Final Inspection has been completed and the Certificate c
occupancy issued, Catawba County Building Inspection will request the power/gas company t
disconnect the main service to the building.
The undersigned makes application for permits and inspection of work described and agrees t
comply with all State, County, codes and laws regulating the wor
Signature ofzffli�61F" Si /Mechanical Contractor ature of owner o Agent
Building Code
Sworn to and an day of E.
'S C,
. 61: 0,
Co %0-
Official Seal
;A..
Signature of Notary Notary Public
0
My commission expires )"A 200 LIP
—A
**This form must be notarized if signed out of office. r-3
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