HomeMy WebLinkAbout1311 Golf Course Rd - Building
fOR OffICIAL USE ONLY:
DatcRcc.:
Penni..: .7;2 3y
Date Approval:
Dale Issued: <--. t
ELECTRICAL PERMIT APPLICATION
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
FBI number: (360) 417-4711
Applicant and/or Agent: f},t> 5 ckc-4(~/
Property Owner:
Address: City:
Phone: 1'S-2.~C,7..>3 Fax #
Phone:
Contractor
Address:
License #:
City:
Exp:
Zip:
Phone:
Zip:
Credit Card Holder Name: S~ C:R....'j / 1:.
Billing Address: ,-~'I b &..,U,.>-.g III I2/.
Credit Card Number ,-
Permit Fee:(I. 4'1 ~
~4c.k
CitY./lJR.I-~9f'~< Zip: ~i'J6"?
Exp. Date: VlSA_ MC X-
.
PROJECT ADDRESS:
LEGAL DESCRIPTION: Lot:
/3/1 ~~_~ e2. .(g~J_ZONING
Block: Subdivision:......
CLALLAM COUNTY PARCEL NUMBER:
TYPE OF WORK:
o Residential 0 Multi-family 0 Commercial 0 Mobile Home
Electrical Permit fees are based OD WAC 296-46-910
BRIEF DESCRtP1:ION OF THE PROJECT:
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/!.u1AdJ d
Electrical Heat Load Additions
. Service Information
a Baseboard
a Furnace
a Heat Pump
a Fan-Wall
KW
KW
KW
KW
o Riser
o Overhead Service
o Temp Service
o Underground Service
Voltage:
Phase: 0 I a 3
Service Size:
Feeder Size:
Comments:
I hereby certify that I have read and examined this application and know the same to be true and correct, and I am authorized to apply
for/his permit. I understand it is not the City's legal responsibility to determine what permits are required; it remains the applicant's
responsibility to determine what permits are required and to obtain SU~Pi . tP
PW.II02_23 (rev3/.00] Credit Card Holder's Signature: ~ R ~l:' Date: 5 -;;)3 -Olaoo