HomeMy WebLinkAboutB3-1505 TEMP ELEC APPL.PDF(828)465-8399 Office Number P,O. Box 389
(828)465-8962 Fax Number Newton, NC 28658
CATAWBA COUI= APPLICATION FOR PERMIT
(COMMRCIAL ONLY)
(Please print or type) Date
#*�--
Temporary Electrical Temporary Mechanical
U
I J- ilding Permit No, (If Applicable)
N
Property ID No. Use of Structure
)lPhysical Street Address (city)
�Q Owner A/ 19 /7:1- Telephone(
Last First
Owner's Address ,,- - 0 , /� e-> x 5 -5 .� /
City State Zip
76) <�-
/Subcontractor
41
—Tel ephone
(As Listed in License Boo
Subcontractor Address 'a,C42.
City State Zip
State License No. & Classification County Account No,
General Contractor J,
Telephone
i LL—)
Location of Structure or Project
(Physical Directions, Road Numbers and Names, Etc,)_
This agreement between Catawba County and (Owne
or Authorized agent)authorizes temporarypowerte rary mechanical service to be establishe
on the Building for above named project for a day period,
This agreement does not constitute a Final Inspection for Electrical Power/Mechanica,
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 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 7'A unly with dersigned makes a p ication for permits and inspection of work described and agrees tc
c41 Co nd ty, codes alaws regulating the work.
Lure
:
ure of Electrical l Contractor Siatu of Owner or Agent
u*dingCode official
a o".
t d sub scribed 0
and ere me this day of 20
Wx C t
N Official Seal
Signature 0f Notary
MY commission expires Notary Public
20 Wo % (1`3 L 'a C
I \ALM **This form must be notarized if signed out of office.
WT
C 0 Lui