HomeMy WebLinkAboutB4-794 TEMP ELEC-HEAT APPLS.PDF06/09/2604 1,4:29 7044992267 LAKE ELECTRIC CO PAGE 01
jk4n uv U1 tit :51p Cit-tt oT Kickard- 9"3r2a7474 P. t'
369
(628)465-0962 flax Number -ILI
CATAWBA COMM AFFLMNTION TOR PRAWT
V.
<;, (COHMz*C= ORLY
t, or typel
Temporary Electrical
—4l aaalIding Permit No, (rf Applicable)
Property M NoUse of Stnicture--
Physical Street Addre**-�. �'57-t'� �.
Own e r
Last Telephone
First
Owner's Address
city - - - Stag �st e
Te 3 ephone
(A# Listed in License, book) ----------
-a I . —
Subcontractor Addre**
0
State License NO, & Classification
—1L5 U-1--county Account
5eroral COntraCtor DA., V 4L4
LocAtion of Str Telephone stvi 1 "-,q
ucturt or Project (phy&" l-'a
Los, rectlong, goad
':�d nams
Numbers
ihis—agreement between Catawba County end
or Authorized *9ed`04Uth*r1Zes tempord (Owner
the Buildi
ry p0wer/temporary mechanical service to be established
on ng for sbov* named project for & ds,), period.
Thts agreement dnew. hot c=a"tut* A Pinal lbap=ctiun
Service. WO further raises for Electrical (wet/Mechanical
&rise from this agreement, e catowba county and its employees fzcm�afty lightlity which may
The partieo acknowledge that Occupancy 4f a-building-wIthout a Certificate of Occupancy is
& violation of runs' and Start law and eXp9aftg the ViOl8tminaan
d nd civil manC
t
lf or to criOccuPancY Occurs before Final 't Aon'
Inapectif h" b*fw camp Off -Ott and the Certificate of
Occupancy issued, Cart4wbarcounty Building rulp,00tion will request the wart as co y to
disconnect the main service to the buildihge Moen
Toly he undersignall ad makee, tate, applintcation for permits add inspection of work described and agrees to
cmpwith SCoUy, codes and IWO rBgUJ#tjNg tbA-- work.
Signature f S1 tri ;talCO'nRrac—tor
S' a 0 f �0 r �®r A�gent
uil irKy Code official
tri ore me thiO,
lonaturo f- 19, uil Ma. official
� and a Ore �me t�hJAI
S- to cc in day o
f
0 Ole
'.t'r
s fky
�re Notary P
t-m
20
Thi . f.
a
ari NO
Pula),
W
4
.41, 'st
',*-00L N
P.O. Box 389
(828)965-8399 Office Number W
Newton, NC 28658
(828)465-8962 Fax Number
TA A COUNTY APPLICNTION FOR PERMIT
(COMMERCIAL ONLY)
Date
(P ase print or type)
Temporary Electrical ✓ Temporary Mechanical
Building Permit No. {If Applicable}
Use of Structure
Property ID No,
Physical Street Address t_
Owner Telephone( 1
Last First
Owner's Address
State Zip
Subcontractor C N T'M nKw Telephone( ) # z2 #
(As Listed in License Book)
Subcontractor Address
City State Zip
State License No. & Classification %' County Account No.
G mo .
General Contractor Telephone
Location of Structure or Project (Physical Directions, Road Numbers and Names, Etc.),
This agreement between Catawba county and \- ° "' + 447. , (Ow
or Authorized agent)authorizes temporary power/temporary mechanical service to be establis
on the Building for above named project for a day period,
This agreement does not constitute a Final Inspection for Electrical Power/Mechani
Service, we further release Catawba County and its employees from any liability which
arise from this agreement.
The parties acknowledge that occupancy of a building without a Certificate of Occupancy
a violation of local and State law and exposes the violator to criminal and civil sancti
if occupancy occurs before Final inspection has been completed
and the Certificate
Occupancy 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
compll State, County, codes and laws regulating the work.
Si a ure f— /Mechanical Contractor Signature of Owner
or Agent
4 9
uil ing Code Official
before this day of.\\
0%I °at"+trr,rr
Sworn to and subscribed me
4 Cj rr
®®®.�.
`0,A
Official Seal
�� '
^� f^} '•
Siature of Notary NotaryPublic
y "��
My commission expires (9`�� `00
spy`•,
*This to must be notarized if si ed out of office.
o.~c)
!:l tMf tl 1 \TM Y
� 6,"(�"°• a°" Via° 4
'4 A
'sA� ®e•.a..0 ar
oe
�q J y \e
T r