HomeMy WebLinkAboutB4-317 TEMP ELEC APPL.PDFBox 389
(828)465-8399 Office Number Newton, NC 28656
(828)465-8962 Fax Number If',) ,
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6UNTY APPLICATION FOR PERMIT
C TkAAA
Date
)Please print or type) 4---
-Z—Temporary Electrical Temporary Mechanical
- 1 Building Permit No. {If Applicable)
Property ID No.
Use of Structure
M.
Physical street Address
Own e
Telephone(&
Last First 3"P
0wner,s Address lac- 5
City State Z'-
;�-A2_Z 1-7 4/& All��"7 Telephone (5�)
bcoi r ractor
(As Listed in License Book) Z/
Subcontractor Address_Z
City State 2P
-) 3
S'�at'e License No, & Classification L County Acqount-Nc
- lj_* 070)
Genera? Contractor & 1
�Telephone (F2
,
--Location of Str�tur�e!`oAro Project {Physical Directions, toad Numbers and Names, Etc
This agreement between Catawba County and — I (Own E
or Aut,horized agent)authorizes temporary power/temporary mechanical service to be es,,abiishE
on the Building for above named project for a _31_0 day period.
This agreement does not constitute a Final Inspection for Electrical Power/Mechan]'_'a
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 1
a violation of local and State law and exposes the violator to criminal and civil sancticr.
it occupancy occurs before Final Inspection has been completed and the Certificate c
occ,_,pancy issued, Catawba County Building Inspection will request the power/gas company
disconnect the main service to the building.
The undersigned makes application for permits and inspection of work described and agrees
comply with all steXe, C�qunty' to a a regulating the work,
�5'?Zture of Electrical/ 1 C retractor Signazure o"f-Owner or Agent
Building Code Official
Sworn to and subscribed befor me this — day of 26
Signature of Notary
Official Seal
Notary Public
My commission expires 1 20
—This form must be notarized if signed out of office.