HomeMy WebLinkAboutB3-1158 TEMP ELEC APPL.PDF(828) 465-8399 Office Number
!828)465-8962 Fax Number
P, 0 Box " �,
Newr-on N" 26,1`
CATAWBA CO=Y APPLICATION FOR PERMIT
Please print or type) Dare
bTemporary Electrical Temporary Mechanical
-*ilding Permit N0,(If Applicable)
Property ID No,Use of Structure
PhysicalStreet Address 1Z N
-4Q� A/
Owner s U,-, Alls
LTelephone(
Last First
Qwner,S Address </ 0 :), /
41,6C.
(As Listed in License Book)
S�!icontractor Address— P0 04�
S,-a,e License No
/—/a,C—
City
State
Telephone( -32Y -F300
/1, C- Kopf
City I State
&Classification County AccouTit No
General Contractor
I Telephone(
_._vocation of Structure or Project (Physical )directions, Road Numbers and Names, ELc
This agreement between Catawba CoLmty and
cr Authorized agent)authorizes temporary power/temporary mechanical service --o —he"
On the Building for above named project for a day
TnS agreement eriod,
does not constitute a Final Inspection fopr Electrical Power/,Mecna,-,,�--�
� 3-0--
service, we further release Catawba County and its employees from any liability 7-,
arise from this agreement,
`'.'he pai'Li,es acknowledge that occupancy of a building without a Certificate of
a violation of local and State law and exposes the violator to criminal and civ-,!
sand r;r
If occupancy occurs before Final Inspection has been completed and the Cer-t-,flcace
Occupancy issued, Catawba County Building Inspection will request the Power/gas compa:-:,?
"Iscorinect the main service to the building.
The undersigned makes application for permits and inspection Of work described and agrees camp, with all State, County, codes and laws regulpr �—in the work
r
of ct �
S-,g-na�ure I e c a ;0
S19-,"aLure of ectr*ca Contractor S1/4n ure of Owner or Agent
Building Code Official
S,,,,o rn to and subscribed before me hisrat ADA, day of
-I ao.,
K C
'vwxvv, -V .... ...
0
A
5ignacure of Notary Official Seal
(0
y commission Notary Public
m
ion expires 1��NA-
2 0
"This form must be notarized if signed out of office, 0: 1
-
-k�