HomeMy WebLinkAboutB2001-181 TEMP ELEC APPL.PDF(828)465-8399 Office Number P.O. Box 389
(828)465-8962 Fax Number Newton, NC 28658
CATAWBA COUNTY APPLICATION FOR PERMIT
(COMMRCIAL ONLY)
(Please print or type) Date t0
i]Lemporary Electrical Temporary Mechanical
(f)(A) 2- 1 Building Permit No. (If Applicable)
Property ID No,
Physical Street Address )'tea 5,5 'R>u(2_Ve, COVJ
owner N \A
Last First
Owner's Address as a> Y\V�
Use of Structure
LL� �(C i It) q �14 2 1 �Ila
�_l "I N't, C, fL
City
Subcontractor \�dlkll
Subcontractor Address fc
State Zip
C"'D I � i ;��'
Telephone (Zwl 3118/_6 V
City State Zip
State License No. & Classification County Account No,
General Contractor l Telephone
42EL
Location
of Structure or Project (Physical DiLrections, Road Numbers and Names, Etc,)
This agreement between Catawba County and —IIA-6 v ('A') IJ 12 C (Owner
or Authorized agent)authorizes temporary power/temporamechanical service to be established
on the Building for above named project for a 3y) day period.
This agreement does not constitute a Final Inspection for Electrical Power/Mechanical
Service. We further release Catawba County and its employees from any liability which may
arise from this agreement.
The parties acknowledge that occupancy of a building without a Certificate of Occupancy is
a violation of local and State law and exposes the violator to criminal and civil sanction.
if occupancy occurs before Final Inspection has been completed and the Certificate of
Occupancy issued, Catawba County Building Inspection will request the power/gas company to
disconnect the main service to the building,
The undersigned makes application for permits and inspection of work described and agrees cc
comply with all State, Countdd
1) y, codes anlaws re Mthe work.
-J�
gn a r , e of E 1 trical/meeha-xr� Contractor S i guature of 0 r, car
t 9441",
u in IX
B Code Official
orn to and subscribed before me this 3b day of 20 Cifx.
"A
)�Clln .. CS Official Seal
Signature of Notary 7 N'7,
biota Public
MY commission expires L
AL 2 OA
"'\, **This form must be notarized if signed out of office.
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