HomeMy WebLinkAbout719 1/2 E 3rd St - Building
FOR OFFICIAL USE ONLY:
DatcRcc.:
Permit #: 7 ~ ~ '"2-
Date Approved:
0.10111_ -? / / "7/' /
ELECTRICAL PERMIT APPLICATION
The Electrical Permit Application must he fiOed out completely.
Please type or print in ink. Uyou have any questions, please eall (360) 417-4735
Fax number: (360) 4174711
Applicant and/or Agent: :819/;'.$ 2..kclteic. Jvc,
<:Y'AAM'./
City:
Phone: ~S 7 - GgJ'7 Fax # Y.sZ' 9?~J'
Phone:
Property Owner:
Address:
Contractor
License #:
Exp:
Zip:
Phone:
Zip:
Address:
City:
Credit Card Holder Name: c.*R {)L Gud.g E /
BillingAddress: ..2~9.~ D~~;e p~ k.. ~d. CifY.8d~E,,{.{ Zip:~d'j'6L
Credit Card Numher ~ Exp. Date: VISALMC_
Permit Fee: 7 ~ 3 l)
PROJECT ADDRESS:
LEGAL DESCRIPTION: Lot:
7/ 7~ (':-
.3 ./'..(
ZONING
Block:
Subdivision:
CLALLAM COUNTY PARCEL NUMBER:
TYPE'OF WORK:
riesidential D Multi-family D Commercial 0 Mobile Home
Electrical Permit fees are based onW AC 29646-910
BRIEF DESCRIPTION OF THE PROJECT:
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Electrical Heat Load Additions
Serviee Information
D Baseboard
o Furnace
o ijeat Pump
8'Fan-Wall
KW
KW
_KW
-4-KW
Cl Riser
D Overhead Service
D Temp Service
D Underground Service
Voltage: Il~/ l-<f 0
Phase: ~
Service Size:_
Feeder Size:
Comments:
I hereby certifY that [ have read and examined this application and know the same to be true and correCl, and [ am aulharized 10 apply
for /his permit. [understand it is not the City's legal responsibility to determine what permits are required; il remains the applicant's
responsibility to de/ermine what permits are required and to obtain such.
I'W_~ 1/22_D CCft"J/.DDj
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