HomeMy WebLinkAboutB4-276 TEMP ELEC APPL.PDF(828)5-539 Office Number
(626) 465-6962 Fax fit r l o
xPERMIT
Jo'.�:'G �� f ° (CCU)WRCM o )
(Please prim or type)
Temporary Electrical
L �t Building Permit rho. (If
f ,.
Property ID No.
Physical Street ddressi'"
.o. Sox 389
Newton, NC 28655
Date :
L!2y—
use of Structurelw--/t—jcf�r
BE
owner Telephone( )
Last First
owner's Address
License Book)
Subcontractor Address /
U
MI
State Zip
Telephone( )
State Zip
State License No. & Classification County Account No.
general contractor G% 6 Telephone132
4Names, Etc.)
Location of Structureor Prof ct
Fh—l—sagreement between Catawba +.
temporaryor Authorized agent)authorizes
on the Building for above named project day perioi
releaseThis agreement does not constitute a Final Inspection for El
Service, we further s s employees
arise from this agreement.
The parties acknowledge that occupancy of a building without a C;
a violation of local and State law and exposes the violator to or
if occupancy occurs before Final inspection has been complete
occupancy issued, a County Building . request
disconnect the main service to the building.
The undersigned makes application for permits and inspection of wc
codes
Building Code official
sworn to and subscribed before me this day of
Official Seal
Signature of Notary °- , der Not Public
my commission expires---� s 20 ��
**This form must be notarized if signed of office.
C7� (O e:
service to be establishes
ctrical Power/Mechanics:
i any liability which ma,,
rtificate of occupancy i!
minal and civil sanction
and the Certificate ol
the power/gas company t(
20 ") 4.�
OFFf lAl SEAL
�.,. tVotery P�dCxSlr t�k�arth Care�;ina
(CATAWBA COUNT'
DC NNA J EH.9ER~,