HomeMy WebLinkAboutB3-893 TEMP ELEC APPL.PDF(828)465-8399 Office Number
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CATAWBA COUNTY APPLICATION FOR PERXII
(COb=RCIAL ONLY)
(Please print or
V Temporary Electrical Temporary
�,. uilding Permit No, (If Applicable)
Property ID No, Use o
Physical Street Address: 12
owner ilk V+ A,/
—Teli
Last First
Owner's Address
Subcontractor
(As Listed in Dice se Book)
Subcontractor Address 6'?/ 2 7'pl, Y91
0
city
City
State License No, & Classificati=124��,J
_DVVA( JP.O. Box 389
N me
on, NC 28658
Structure e�ll -1
R
(el--16 )
41 e:
State Zip
Te 1 a' phone )_3 g 2
General Contractor Tel
—Location of Structure or Project (Physical Directions, Road N
Ve �2w6al
State Zip
ty Account No.
one_L),
erg and Names, Etc,)
This agreement between Catawba County and
or Authorized agent) authorizes temporary (Owner
Power7te�rary m-echan-ical e ice o �ire es`tab'lished
on the Building for above named project for a — 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 tc
disconnect the main service to the building.
The undersigned makes application for its and inspection of work described and agrees to
comply with all tate, ty, codes and laws regul ing the work.
"y Signature of Electrical/S
signature of er or Agent
Building Code
Sworn
Official
to and d
subscribed before me this
day of
20
Signature of
otary
Official Seal
M My commlss
Y commission
expire 's 0-
pi_aLL 1--,
Not Public
20 D
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"This form must be notarized if signed
— 0 F:
out �f office, Notary P-WIC - N011h Carohrm
CATAWBA COUNTY
DONNAJ KETYH�RSID