HomeMy WebLinkAboutB1103-452 TEMP ELEC APPL.PDF(828)465-8399 Office Number P.O. Box 38�
(828)465-8962 Fax Number W Newton, NC 26658
CATA I k fC01UNT APPL CAjTTJH FOR VERMIJ
'Please print or type) Date
bla-�Bz' PTemporary Electrical Temporary Mechanical
Z4uilding Permit No, (If Applicable)
Property
ID No.
Physical
Street Address—:, 3
Own e r
Owner ls Address
city
Use of Structure
(City}
State
S',,ibcon, ractor- Telephone (10
EAs Listed in Licen�sce hook}
Subcont racror
C' y State
SraLe License No, & Classification o4e�''/ � County Account
Na General Contractor E (n A Telephone( ag)
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ocat 0 f S ZW ructure _9_r Projech (PhTical Dir7'ct1Qns, Road Numbers and Names, Etc,
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Th.,_9 agreement between Catawba County and {owne
or Aurhorized agent}authorizes temporary power/temporary mechanical —service "tobe
on the Building for above named project for a _� � day period, esuablisne
This agreement does not constitute a Final Inspection for Electrical Power/mechar-,-�ca
Service. We further release Catawba County and its employees from any liability which Ma
arise from this agreement.
The parties acknowledge that occupancy of a building without a Certificate of occu'panc,"
a violation of local and State law and exposes the violator to criminal and civil sancticn
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
disconnect the main service to the building.
The undersigned makes application for permits and inap on of work described and agrees
cq,mply with all Otate/, County, codes and laws regu Gi t e work.
a Lur e
S acure of Electr,ical/Aechanical Contractor store of wner r Ag
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Bu ding Cede Official '-:A -
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Official Seal
Signature of Notary
Notary Public
my commission expires ____A- 20 0
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—This form must be notarized if signed out of —office.
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