HomeMy WebLinkAboutB3-611 TEMP ELEC APPL.PDFUblIJ/ZUV4 UVAO rAA 046444VVie 4 aea�Qllb dedL 64 All' WJ V V I
P.O. Box- 191
(820)465-0399 of ice Number Newton, NC 28656
c+65-0962 pax Number W
x— to 72RXIT
C,&TAWBk COMM APPLIC.&TION FOR
(COM"RCIAL ONLY) ,
Date
a (Pleaselorint or type)
Temporary Vlactrical Temporary mechanical
3 b3- tR \\—Building Peit00, (If Applicable)
Property ID No. -3 Use of Structvre
;hysical street Address (CitL6
60
Owner Telephone J1_.!,�t
at First,
L 16 mc_
owner,* Address
city State Zip
C
subcontractor R-\ r Telephone ,.L
(A,# Listed in License nook)
1-DI.
Subcontractor AddressCity State Zip
State License No, 4 unty Account No,.
�wftemrai contr*ctor___ Telephone
t,ocation of structure or Project (Physical Directions, Road Numbers and Names, Etc
I I *
�Fhiv agreement between Catowbo County and (owner
or Authorized arizow tempora P0400 aim aranuryy mechAnical service to bo- e-scat�liaheql,
on the Building for above named VrcjeZc_fvr!;�i0 It day period.
Final
This agreement does not conatitutow 6 Final napaction, for Electrical Power /Mechan 1ca I
service, we further release Catawba County and its employOVIN from any liability which may
wriwe. from this. agrs*Wt
The parties acknowledge that occupancy of a building without a Certificate of Occupancy Is
a violation of local and State law and expose* the viola,tor to criminal and civil sanction
It oc"p*ncy occurs before Final inspection has been completed and the Certificate Qt,
Occ4pancy issued, Catawba county building inspection will request the power/goo company to
disconnect the-mairr #VTVic*-M-CtWbU-ildirq-,
The undersigned makes application for permits and inspection of work described and agrees to"",.
comply with all SratvI CoI c lavwl ating the work.
ature of Flactrica.1#4achariloal Contractor Signature of Owner or Agent
8V ; in g Code- Official
Sw to and subscribed before me this day of
Official Seal
Signature of Notary Notary Public
my commission expires
—This form must be notarized if signed out of office.
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