HomeMy WebLinkAboutB4-273 TEMP ELEC APPL.PDF(828)465-8399 office Number
(828)465-8962 Fax Number
kkW"BA, COMM APPLICATION FOR PERMIT
�,Vv��,,�fqXHXRCIAL OITL�)
Ul)ok 61�
P ease print or type)
V /\, _Temporary Electrical Temporary
ILD1 -7 Building Permit No,(If Applicable)
use of StructureG�d��Cll
Property ID No.
physical Street Addressia�� N(fC0
to
P,O, Box 389
Newton, NC 28658
Telephone(
owner
Last First
owner's Address
kqr s con ra r\-
Im
subcontractor Address
bpolev L-1—k—cl—V4
Listed in License Book)
&
city state 41P
M
Telephone( )
State License No. & Classification
V 11
General Contractor Tel
L-6 9-
Location of Structure or prcl ct (Physical Directions, Road N
Fhis agreement between Catawba County and 11tal V-,
or Authorized agent)aothorizes temporary p er/te ry mec ical
on the Building for above named project f r a 0 day period
This agreement does not constitute a Final inspection for F-1-4
Service. We further release Catawba County and its employees froi
arise from this agreement.
The parties acknowledge that occupancy of a building without a Ce
a violation of local and State law and exposes the violator to cri
if occupancy occurs before Final inspection has been complete�
Occupancy issued, Catawba County Building Inspection will request
disconnect the main service to the building.
The undersigned makes application for permits and inspection of wo,
C-Mply th all $tatee� County, codes and laws regulating the work
47—
Sig-nature of Electrical/i4echanical Contractor Signature of Owne
Building Code Official
Sworn to and subscribed before me this day of
UkJ Iofficial Seal
Signature oftar A Notary Public
My commission expires d 2 0_(��
This form must be notarised if signed out of office.
State zip
ty Account No.
ne
re and Names, Etc,)
—01 , (Own e r
service to be established
ctrical Power/Mechanical
any liability which may
7tificate of occupancy is
ninal and civil sanction
and the Certificate of
the power/gas company tc
k described and agrees tc
$204
OFFICIAL SEAL.
,-wy Pobltc Norlh Cwnna
CA'TAWBA COUNTY
DONNA J KETCHERSID