HomeMy WebLinkAbout724 E 9th St - Building
ELECTRICAL PERMIT APPLICATION
FOR OFFICIAL USE ONLY:
Date Rec.:
Permit #: 71 (j' V
Date Approved: I' ~
Date Issued: '~?# I
The Electrical Permit Application must be filled out completely.
Please type or print In Ink. If you have any questions, please call (360) 417-4735
Fax number: (360) 4174711
Applicant and/or Agent: f) f> 5 tEkc/,e,CA/
Property Owner:
Address: City:
Phone: 1"S-Z.~C,7.>3 Fax #
Phone:
Contractor
License #:
City:
Exp:
Zip:
Phone:
Zip:
Address:
Credit CardHolder Name: S~ cl!-'(I I!..
Billing Address: .5''1'' &-IU~'&I\J ~
Credit Card Number
WSA_ MC X-
.
Block:
(fc r#S \
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Subdivision:
ZONING
PROJ'ECT ADDRESS:
LEGAL DESCRIPTION: Lot:
7;;L <( ~'l~
CLALLAM COUNTY' PARCEL NUMBER:
TYPE OF WORK:
o Residential 0 Multi-family 0 Commercial 0 Mobile Home
Electrical Permit fees are based on WAC 296-46-910
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BRIEF DESCRlPUON OF THE PROJECT:
Electrical Heat Load'Additlons
Service Information
o Baseboard
o Furnace
o Heat Pump
o Fan-Wall
KW
KW
KW
KW
o lUser
o Overhead Service
o Temp Service
o Underground Service
Voltage:
Phase: 0 I 0 3
Service Size:
Feeder Size:
Comments:
[ hereby cenifY that I h'ave read and examined this application and know the same to be true and correct. and I am authorized to apply
for Ihis pemrit. I understand it is not the City's legal responsibility to determine \WIat permits are required; it remains the applicant's
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PW-ll02.23 [n:v31.00J Credit Card Holder's Signature: . R. ~.i' Date: S <23 -01.000