HomeMy WebLinkAbout627 1/2 E 8th St - Building Electical Permit
6271/2E 8t" St
11 - 877
ELECTRICAL PERMIT `
CITY OF PORT ANGELES
360-417-4735
Application Number . . . . . 11-00000877 Date 8/16/11
Application pin number . . . 932854 REPORT SALES TAX
Property Address . . . . . . 627 1/2 E 8TH ST our excise tax form
ASSESSOR PARCEL NUMBER: 06-30-00-0-2-2685-0000- ony
Application type description ELECTRICAL ONLY to the City of Port Angeles
Subdivision Name . . . . . .
Property Use .
(Location Code 0502)
Property Zoning . . . . . . . COMMERCIAL NEIGHBORHOOD
Application valuation . . . . 0
----------------------------------------------------------------------------
Application desc
New home 1300 sqft
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Owner Contractor
------------------------ ------------------------
DANA AND RHIANNA SHALTRY EXTRA MILE TECH & ELECT., LLC
611 E STH ST 418 N. RACE ST. h
PORT ANGELES WA 983626223 PORT ANGELES WA 98362 v\
--- -(360) 457-4991 (360)-457=0198 �57 �/ L - --
Permit ELECTRICAL NEW RESIDENTIAL g
Additional desc
Permit pin number 191072
Permit Fee . . . . 110.30 Plan Check Fee .00 1
Issue Date 8/16/11 Valuation . . . . 0 �\
Expiration Date . . 2/12/12 '_vf
Qty Unit Charge Per Extension I
1.00 110.3000 ECH EL-R-SQFT FIRST 1300 110.30
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 110.30 110.30 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 110.30 110.30 .00 .00
INSPECTION TYPE DATE: RESULTS: INSPECTOR:
DITCH
SERVICE
ROUGH-IN
FINAL
COMMENTS:
PERMIT WILL EXPIRE SIX(6)MONTHS FROM LAST INSPECTION
Signature of owner or Electrical Contractor X Date:
G:\EXCHANGE\BUILDING
OF VORT4,V, ELECTRICAL INSPECTION
1 CF
Ulr�- WIRING REPORT
G`
RKS& 417-4735
DATPERMIT# INSPECTOR
hL
Z -
OW N ER/CONTRACTOR
t .
ADDRESS
627
APPROVED NOT APPROVED
❑ . . . . . . . . . . . . . . . . . . . . DITCH . . . . . . . . . . . . . . . . . . . . ❑
❑. . . . . . . . . . . . . . . . ROUGH IN/COVER . . . . . . . . . . . . . . . ❑
❑. . . . . . . . . . . . . . . . . . . . SERVICE . . . . . . . : . . . . . . . . . . . 0
#� 1 Ash. . . . . . . FINAL . . . . . . . . . . . . . . . . . . . . ❑
CORRECTIONS NEEDED: P!15 9
ti
NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
- DO NOT REMOVE -
OLYMPIC PRINTERS,INC.(360)452-1381
AUG-15-2011 09 :29 AM E. JANSSEN 360 452 2982 P. 01
i
d�
RECEIVED 1
i��r•cisr,t,��.
`\tivr�J
CITY OF PORT ANGELES PERMIT APPLICATION AUG 1 207'
Building Division/Electrical Inspections ELECTRICAL or
321 East Fifth Street—P.O.Box: 1150/ Port Angeles Washington,98362 INSPECTIONS
Ph:(360)417-4735 Fax, (36,0)417-4711
oa : `r� • r S"�--- I 1
,r!.1 &2 Single Family Dwelling vlulti-Family or Commercial` Commercial Addition/Alteration/Remodel/Repair'
'Flan Review May Be Required, Please Complete Electrical Plan Review Information Stirs:
JobAddreev ___ ._..1cz. ._/•, _• .� C1 ''' STitL'rT
Building Square Footage: —
Description of above_ _1 M-. ...._._,. ._.__<. .l'�: . _... . . .L c A
Owner In f orrnation Contractor Infonmetlon
►i jj(c'►.1 Name: X7/1.7• rYil4r' -7,W604 it 4�I�fT'jzrc*C.
MaINng Address f _._.
MalUn�Address.
City:-,c g,± 1144elj State:.1.2A ,dip city .1�c,� .J.�r_�cf..c SMty wit 21p ci9 k2-
phona: L&Q n6, �G o Fax:--. .
,.. Phone:'/S'7�5_1a;:i. Fax: �/S'7 - Y,''�S'
Liwnser!lExP
License#/Exn. .�..: A��"YJ-3RD
HAM Unit Cha a -Qty Tohl((2/v Mutt 0W by Unit Charge]
Service/Feeder 200 Amp. ,1191)0 $�
SwvIce/Peeder 201-000 Amp. S 145.50
Service/Fewer 401.600 Amp $204.60
Service/Fewer 601-1000 Amp. :6 262.20 $
Service/Foeeoer over 1000 Amp. $372.50
Branch Circuit WI Service Feeder 'S 2.60 $.__.—_�____
Branch CUrull W/O.service Feeder :; 73.60
Each Additional Branch Circult 5 2.60
Temp.Servlcel Feeder 200 Amp. $ 92.70
Tw W.Service/Feeder 201400 Amp. .1110.30 $
Temp.SerAWFeeder 401.600 Amp. $148.70
Temp,Servl(xe/Feader601-1000 Amp $167.90
Portal to Portal Hourly 3 95,90
SlgrdOuAlno Ughting $ 118,20
Signal CImrIU Umited Energy I First 1500 sf-•C.ammprrmi $ 9590
Note: $5.00 for each additional 1$00 sr
Slgnel Drcull/Limited Energy-16 2 Family Dwelling $ 63.90 _._..... ..... $..____ ^_:.._.
Signal Circuid Limited Energy-Mullt-Family Dwelling $ 63.90
Manufactured Home Connection $11990 $._•.,,____—
Renewable Electrical Energy-6KVA Eysfhim or Leos $102.30
Thermostat $ 56.00
KIN MMUOMMt.
F#st 1300 Square Ft. $110 30 $,,,,,(_r I �_ '
Each Additional 500 Square Fl,or Porliof 0 S 35.20 _ $ M
Each Outbuilding or Detached(kirage S 73.50
Each Svnmminq Pool or Hot Tub $11030
Total
Owner as defined by RCW.19.2B.261 (1)Owner willoccupy the structure for two years eller this alt ctrical permit is flnatized.(2)Owner is requ#ed
to hire an elechical contractor it above said property is for sale,rent or lease,Permit expires after sw months of last inspection.
After reading the above statement,I hereby certify that I am the owner of the above named property or a licensed electrical contractor.I am mak.ing
the electrical installation or alteration in compliance with the electrical laws,N,E,C.,RCW.Chaptef 19.28,WAC.Chapter 2964613,The City of Part
Angeles Municipal Code,and Utility Specifications and PAMC 14.05.050 regarding Electrical Perini;Awlications.
'Signature of owner,electrical contractor or electrical administrator 1:1. rash �`nick
01N1t101a
ELECTRICAL PERMIT
CITY OF PORT ANGELES
360-417-4735 S�
Application Number . . . . . 11-00000946 Date 9/16/11
Application pin number . . . 738964 REPORT SALES TAX
Property Address . . . . . . 627 1/2 E 8TH ST Or) our excise tax form
ASSESSOR PARCEL NUMBER: 06-30-00-0-2-2685-0000- y
Application type description ELECTRICAL ONLY to the City of Port Angeles
Subdivision Name . . . .
Property Use (Location Code 0502)
Property Zoning . . . . . . . COMMERCIAL NEIGHBORHOOD
Application valuation . . 0
----------------------------------------------------------------------------
Application desc
T-stat remodel
----------------------------------------------------------------------------
Owner Contractor
DANA AND RHIANNA SHALTRY ALL WEATHER HTG & COOLING INC
611 E 8TH ST 302 KEMP ST
PORT ANGELES WA 983626223 PORT ANGELES WA 98362
(360) 457-4991 (360) 452-9813
-
------------------- ----------------------------
----
Permit ELECTRICAL ALTER RESIDENTIAL ) v
Additional desc . .
Permit pin number . 191916
Permit Fee . . . . 56.00 Plan Check Fees . .00
Issue Date . . . . 9/16/11 Valuation . . . . 0 ��-
Expiration Date 3/14/12
Qty Unit 'Charge Per Extension
1.00 56.0000 ECH EL-LVT-THERMOSTAT 56.00
----------------------------------------------------------------------------
Special Notes and Comments
August 31, 2011 10:43:30 AM tamiot.
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
Permit Fee Total 56.00 56.00 .00 .00
Plan Check Total .00 .00 .00 .00 U
Grand Total 56.00 56.00 .00 .00
V
DR ill-3i)-_1
INSPECTION TYPE DATE: RESULTS: INSPECTOR:
DITCH
SERVICE
ROUGH-IN ' 1)
FINAL
COMMENTS:
PERMIT WILL EXPIRE SIX(6)MONTHS FROM LAST INSPECTION
Signature of owner or Electrical Contractor X Date:
G:\EXCHANGE\BUILDING
08/29/2011 14:46 13604525177 ALL WEATHER HEATING PAGE 03/03
RECENF,
C
CITY OF PORT ANGELES PERMIT APPLICATION
Building Division/Electrical Inspections AUCI
1 3 0 201
321 East'Fifth Street—'P.O.Box 1150/Port Angeles Washington,98362
Ph:(360)417-4735 Fax: (360)417-4711 ELECTRICAL
INSPECTIONS
Date: 1
—4L–A &2 Single Family Dwelling —Multi-Family or Commercial* —Commercial Addition/Alteration/Remodel/Repair*
'*Plan Review May Be Required,Please Complete Electrical Plan Review Information Sheet
Job Address: '
Building Square Footage:
Description of above
- 'in�d:ra�l4ad o u
Owner Information Contrac or Info mation
Name:_ Ds Shv.(1,rY Name: �e J G ' �s (bpi
Mailing Ad fess; Mailing Address:
City: State: Zip; d� v
Phone: O Fax; P�e. A State:. W l� Zip:_ b8.
Cleanse#/Exp, A:_q9!.
License 0/Exp. Fax' 3 " _t77
tem Un' Char a g Total(Qty Multlplied b UUnit� Charpol
Service/Feeder200Amp. $119.90 $
Service/Feeder 20100 Amp, $145.50 $
Service/Feeder 401.600 Amp $204.60 $--�—
Service/Feeder 601.1000 Amp. $26220
Service/Feeder over 1000 Amp. $372,50 $$
Branch Clrcult W/Service Feeder $ 2.80
Branch Circuit W/O Service Feeder $ 73.50 $
Each Additional Branch Circuit $ 2.60 $
Tamp,Servicel Feeder 200 Amp. $ 92.70 $
Temp.Service/Feeder 201-400 Amp. $110.30 $
Temp.Service/Feeder 401.600 Amp. $148.70 $
Temp,Service/Feeder 601-1000 Amp, $167,90 $
Portal to Portal Hourly $ 95,90 $
Sign/Outline Lighting $ 88.20 $
Signal Circuiv Limited Energy/First 1500 sf-Commercial $ 95.90 $
Note: $5.00 for each additional 1500 sf $
Signal Circuit/Limited Energy-1&2 Family Dwelling $ 63.90 $
Signal Circulv Limited Energy-Multi-Family Dwelling $ 63.90 $
Manufactured Home Connection $119,90 $
Renewable Electrical Energy-5KVA System or Less $102.30
Thermostat $ 56.00
I ll—CONSTRUCTION ONLY:
First 1300 Square Ft $110.30 $
Each Additional 500 Square FI,or Portion of $ 35,20 $
Each Outbuilding or Detached Garage $ 73.50 $
Each Swimming Pool or Hot Tub $110.30 _ $
$ Total
Owner as defined by RICK 19.28.261:(1)Owner will occupy the structure for two years after this electrical permit Is finalized.(2)Owner is required
to hire an electrical contractor if above said property is for sale,rent or lease.Permit expires after six months of last inspection.
After reading the above statement,I hereby certify that I am the owner of the above named property or a licensed electrical contractor.I am making
the electrical installation or alteration in compliance with the electrical laws,N.E.C.,RM Chapter 19.28,WAC.Chapter 296468,The City of Port
Angeles Municipal Code,and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications.
Signature of owner,electrical contractor or electrical administrator. ❑ cash D Check
❑ Credlt Card#
Gbtetl' �f d q 01/0112010
^^°w� CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT -BUILDING DIVISION
Vff 321 EAST 5TH STREET, PORT ANGELES,WA 98362
. . . . 59 e
Property Address . . . . . . 627 1/2 E 8TH ST
ASSESSOR PARCEL NUMBER: 06-30-00-0-2-2685-0000-
Application description . . . RE-ROOF
Subdivision Name . . . . . .
Property Zoning . . . . .
Application valuation . . . . 900
Owner Contractor
_ ________________________
ARMSTRONG, JOSH OWNER
333 GRIFFITH FARM ROAD
SEQUIM. WA 98382
(360) 457-5752
_____________._.__-___--___--_______
Permit . . . . BUILDING PERMIT - NO PR FEE
Additional. desc . . TEAR OFF, SHEET, FELT, COMP
Permit Fee . . . . 59.20 Plan Check Fee .00
Issue Date . . . . 8/21/03 Valuation . . . . 900
Expiration Date . . 2/18/04
Qty Unit Charge Per Extension
BASE FEE 47.00
4.00 3.0500 HND BL-501-2K (3.05 PER C) 12.20
_________._______________________________________________ _
Other Fees . . . . . . . STATE SURCHARGE 4.50 ^
Fee summary Charged Paid Credited Due _ 4
Permit Fee Total 59.20 59.20 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.50 4.50 .00 .00 \
Grand Total 63.70 63.70 .00 .00
V
Separate Permits are required for electrical work,SEPA,Shoreline,ESA,utilities,private and public improvements.This permit becomes
null and void if work or construction authorized is not commenced within 180 days,if construction or work is suspended or abandoned
for a period of 180 days after the work as commenced,or if required inspections have not been requested within 180 days from the last
inspection. I hereby certify that I have read and examined this application andknow t e same to be true and correct. All provisions of
laws and ordinances governing this type of work will be complied with whether sl) herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any state or I I w reg ula ' nstruclion or the performance of
construction.
-------------------
Signature of Contractor or Authorized Agent Date Sign t re of Owner(if owner is builder) at
T:\PLANNING\PORMS\1102.15[4/20021
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. ITIS UNLAWFUL TO COVER,
INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT INA CONSPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTIONTYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT:#
ROUGH-IN
PLUMBING
UNDERFLOOR/SLAB
ROUGH-IN
WATER LINE
GAS LINE
BACK FLOW/WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS/ GIRDERS
SHEAR WALL
WALLS/ROOF/CEILING
DRYWALL
T-BAR
INSULATION
SLAB
WALL/FLOOR/CEILING
MECHANICAL
HEATPUMP
WOOD STOVE/PELLET/CHIMNEY
HOOD/ DUCTS
PW UTILITIES/ SITE WORK (Engineering Division) SEPARATE PERMIT N's:
WATERLINE/METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT Ws SEPA
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
W
HT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
R.W./PW/ CONSTRUCTION-R.W.
417-4807 PW/ENGINEERING
417-4653 FIRE DEPT.
.
417 4750 PLANNING DEPT.
417-4815 BUILDING
PREPARED 9/10/03, 12:23:32 INSPECTION TICKET PAGE 6
CITY OF PORT ANGELES INSPECTOR JAMES L LIERLY DATE 9/10/03
--------------------------------- --------------------------------------------------------------
ADDRESS . : 627 1/2 E 8TH ST SUBDIV:
CONTRACTOR : PHONE
OWNER ARMSTRONG, JOSH PHONE : (360) 457-5752
PARCEL 06-30-00-0-2-2685-0000-
APPL NUMBER: 03-00000828 RE-ROOF
------------------------------------------------------ -----------------------------------------
PHRNIT: MOP 00 BUILDING PERMIT - NO PR FEE
REQUESTED INSP DESCRIPTION
TYP/SQ COMPLETED RESULT RESULTS/COMMENTS
------------------------------------------------------------------------------------------------
BL99 01 9/10/03JL BUILDING FINAL
Re-roof final
------------------------ --- COMMENTS AND NOTES --------------------------------------
a��"� CITY OF PORT ANGELES
f � DEPARTMENT OF COMMUNITY DEVELOPMENT -BUILDING DIVISION
s 321 EAST 5TH STREET, PORT ANGELES, WA 98362
rya V,,,a
Application Number . . . . . 03-00000854 Date 9/02/03
Property Address . . . . . . 627 1/2 E 8TH ST
ASSESSOR PARCEL NUMBER: 06-30-00-0-2-2685-0000-
Application description . . . ELECTRICAL ONLY
Subdivision Name . . . . . .
Property Zoning . . . . .
Application valuation . . . . 0
Owner Contractor
------------------------ ------------------------
ARMSTRONG, JOSH BOB'S ELECTRIC INC
333 GRIFFITH FARM ROAD 2293 DEER PARK RD.
SEQUIM WA 98382 PORT ANGELES WA 98362
(360) 457-5752
----------------------------------------------------------------------------
Permit . . . . . . ELECTRICAL ALTER RESIDENTIAL
Additional desc 200 AMP/ REMODEL
Sub Contractor BOB'S ELECTRIC INC
Permit Fee . . . . 64.90 Plan Check Fee .00
Issue Date . . . . 9/02/03 Valuation . . . . 0
Expiration Date 3/01/04
Qty Unit Charge Per Extension
1.00 64.9000 ECH EL-R OR RM 0-200 ALT SRV FDR 64.90
Fee summary Charged Paid Credited Due
Permit Fee Total 64.90' - 64.90 .00 .00 _
Plan Check Total .00 .00 .00 .00
Grand Total 64.90 64.90 .00 .00 ,
r
(nI
0 '
W
Separate Permits are required forelectrical work,SEPA,Shoreline,ESA,utilities,private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days,if construction or work is suspended or abandoned
for a period of 180 days after the work as commenced,or if required inspections have not been requested within 180 days from the last
inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction.
Signature of Contractor or Authorized Agent Date Signature of Owner(if owner is builder) Date
T:\PLANNING\FORMS\1102.15[4/2002]
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER,
INSULA IF OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT INA CONSPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE DATE ACCEPTED COMMENTS
YF,S NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION ORAINA617.
ELECTRICAL (LIGIIT DEI"I) SEPARATE PERMIT:9
ROUGH-IN
PLUMBING
UNDERFLOOR/SLAB
ROUGH-IN
WATER LINP.
CTAS LINE
RACK I LOW/WATI.R
Alli SEAT.
WALLS
C1111,ING
FRAMING
JOISTS/ GIRDERS
SHEAR WAIT
W ALIS/ROOF/CF_I LING
DRYWALL
T-BAR
INSULATION
SLAB
W N.I./FLDOR/C131LING
MECHANICAL
HEAT P IMP
WOODSTOVE/PELLP.I"/CHIMNEY
HOOD/ DIICI'S
PW UTILITIES/ SITE WORK (13g, ,nng Dfvfsfon) S17PAIZAI E PERMIT H's:
WATERLINE/MIS I'ER
SEWER CONNECT]ON
SANITARY
STORM
PLANNINGDEPT. SF.PARA"I'LPERMITN'., SEPA:
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE VES NO COMMERCIAL DATE ACCEPTED
YES NO
I:LECTRICAL-LIGIITDEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRI ICI'ION R.W./PW/ CONSTRUCTION-R.W.
ENGINEERING 417-4907 PW/ENGINEERING
199E 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
III❑I)ING 417-4915 BUILDING
1.\PLANNING\FORMS\1102.15[4/20021
FROM BOB'S Electric FAX NO. : 1 360 452 9943 Aug. 29 2003 02:35PM P1
ELECTRICAL PERMIT APPLICATION dRRrr� o�LY
Tho Electrical Permit APplic2401.Mu4t.be fllod out ee�tPIv
pp
lO Please type or reprint In Ink. If you have arty questions,Please call(gee)41 h r67-
r 4735
1 r Fax numEec(360)417-4711
REQUEST INSPECTION
1 D
-���
FaxAsa- 99 /3
Tuner o,Elec.Contractor A ant: N r, E.�tC-F'RL.I" Ph014: ;
Property Owner Phone.
Aodrasc Cly: Zip.
I �r
Eleevical C"I,2ctor, q {L�ic//,�AQnse#ES: EM>Z7�./� ohone:7G�X08 B 7
Address:.. QA6 city �"�.kL t�Sf
INSTALLATION WIRED BY: 0 OWNER ISELECTRICAL CONTRACTOR
CredltCard Holder Name,0—Al^0l, �n
Billing Address. iAee% � zip.ynn (- v �
Credit Card Number_ � �Exp. Date; VISA MC
/^ /�
PROJECT ADDRESS t aS
TYPE OF WORK' Check all that apply: M New 0 Alieration/Addilion
Residential 0 Multi-family 0 Commercial 0 Mobile Home Sq. Ft
Remote Meter 0 Detached garage 0 Hot Tub 0 Swim Pool 0 Septic Pump I-'Low Voltage O Telecom, Sign
Number of Circuits added or altered:___ ZOO /9-77 0
DESCRIPTION OF THE ELECTRICAL PROJECT:
Electdcal Heat Load Additlons PERMIT FEE: boy Service Information
/Vo llyv%do L�ftO
❑Baseboard _KW
V01:399:
O Furoate _ KW E:overhead service Phase: At 0 3
C Heat Pump —TON_LRA Cl Temp Service Servlee Size: 2_�n
❑Fan-Wall KW G Underground Service Feeder Size:
l hereby certify that l have read and examined this application and know that same to be true and correct, and I am
authorized to apply for this permit. i understand It is not the City's legal responsibility to determine what permits
are required;it re/mains the applicants responsibility to determine what permits are required and to obtain such.
Credit Card Hoider's Signature: Date: L O�
Owner or Elec, Cont. Signature: Date: y z� 03
C*IELECTRICALPERMITAPPLICATION