HomeMy WebLinkAboutB3-2154 TEMP ELEC APPL.PDF(828)465-8399 Office Number
(828)465-8962 Fax Number
Property
Physical
Owner —
CCU UNW APPLICATION Frtl PERMIT
(CObMRCIAL ONLY)
print or type)
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P.O. Box 389
Newton, NC 28658
Date__J//L
Temporary Electrical
Temporary Mechanical
(46
71,
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Building Permit No, (If Applicable)
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Use of Structure
Street
Address
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3-11"'A"') 75 /1 el 0
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Telephone
Owner's Address
City State Zip
'Subcontractor
Telephone(
(As Listed in LicenseBook)—
* Subcontractor Address
city State Zip
'State License No, & Classification County Account No.
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General Contractor A -le
�., V, Telephone( Uos Location of StructureI
"o'�rProj�ect (Physical �Direc=ions, Poad Numbers and Names, Etc,)
i°his agreement between Catawba County and
or Authorized agent)authorizes temporary power/te Gi (Owner
rary mechanical service to be establi-h-
on the Building for above named project for a L 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.
Occupancy issued,
If occupancy occurs before Final Inspection has been completed and the Certificate of
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 to
Comply with all State, County, codes and laws regulating the work.
—7--'Tract�
r e of Electrical Contractor Si
store of Electrical/ Contractor signature of o 'at or Agent
A ,f e
Building Code Official
Sr6in to and subac ibed before me this day of
20
Signature of No ary
Official Seal
ry ub
MY commission expires Notaplic20
"This form must be notarized if signed out of office,
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