HomeMy WebLinkAbout3418 Mill Creek Ct - Building
Nov 10 03 01: 05p
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R.W. and F.L. Becker
360-683-6104
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ELECTRICAl PERMIT APPLICATION
The EledricalPennitApplioaliOn must"" IiIJed outcam'-
Please type or reprint In Ink. If you have any questions. please call (360) 417-4735
FaX number: (360) 417-4711
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mer<<EIec. ContradDr Agent: ~ L.J "6 (~~~ #/t.-:7t:.- . Phor1e: hr1 <. '> ":-:.; .f FaJc
opertyOw1ler.~C ,:""'-' '.' [: '" rl::z~\f?k 'SL/STI fi/....;:- Phone:
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~ContradDr: ~t.-.-o'.'~ r:7(-- '---"~"""L,.- LJ\oIl:lI~ -
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Zip:
Phone: 9 ,l: ~ &27
Zip: <; (:3 \-2..
ftLECTRICAL CONTRACTOR
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riling Address; / ,-,---;' I .77-1-'1/ L/lC, C<i./i-(5-/ty;<.; ,"c;2 i-/r":--/
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"(Jeflt Card Number; ' ! Exp. Date; / () '/
STALLATION WIRED BY:
DOWNER
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'edit Card Holder Name:
C '-~/ --;"
Zip; / ,1 j b 4c_
VISA; X MC;
~OJECT ADDRESS: ..:3 zf I 'i( Il-l/ (.L-- L /L.i~-6k.:
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PE OF WORK: Check all that apply: pew 0 Alteration/Addition
Residential ~Ulti-famijy 0 Commercial 0 Mobile Home SQ. Ft
Remote Meter .J2fbetached garage 0 Hot Tub 0 SWim Pool 0 Septic Pump 0 Low Voltage 0 Telecom. 0 Sign
mber of Cift;uil:s added or altered: 1
:SCRIPTiON OF THE ELECTRICAL PROJECT: t-.J',.. 1/..';;-
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~ctrical Heat Load Additions and Ot Subtractlons
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Service lnfOr$a&n
. =.l""ldId
-umace
IeatPUmp
i%
o 0IIeIbead Service
oTemp SeMce
u~se;z AS
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Phase: 0 1
Servioe Size:
Feeder Sire:
03
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m:!by cediIY tbaEl haw: read and examinedtlJis application and know that same to be 1nIe and COI'reCt. and I am
hcJrize4fp-aJlJIIY ftJrthis permiL f U1lfIerstlnd. is not the ~fegaI respoosibiJityto defetmine..mat perm;Is
~the..,.p1i=uzts ~to - ~pemJ!Is are ~ andfo-ol1tain sum.
Credit Card HoJder'sSignat1J....: '/ic-daca' Q..eCA--.- Date: 1/-/07."03
Owner Ot E1ec. ConL Signature: .. -:c:fa 't/c. '_l..e~~" Date: f(~ /()..'r;
fF>1...{(,c..- - iNj ~/ed
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~APf'UCAnON
PERMIT FEE: $ <f t,. ?{)
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ELECTRICAL PERMIT APPLICATION
FOR OFFICIAL USE ONLY
DatdRc:c.
Permit#:
Date Approved:
Datelssuc:d
The Electrical Permit Application must be filled out comoletelv.
Please type or reprint in ink. If you have any questions, please call (360) 417-4735
Fax number: (360) 417-4711
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. Owner or Elee. Contractor Agent:
Property Owner: 'f\J1.oJ ~ ft7I i ~ I 5i sf- I i N2-
Address: ~HS ~A;L'{ CreeK Qt--
-Electrical Contractor: ~cr"'-~;Y' Vt1.lle-j PlM'vlf<7
Address: Po,r.:;r,x. GIO
Phone:
Fax:MI - oS-6'3
Phone:
City:Pt A-v~e..les
License /f.7EGU IVPOO5i<4.xp:
City: &(/ :st...xrr'J
ZiP:.9I!3CoZ.
Phone: It/6 3-42~ I
Zip:~ g~2_L~
INSTALLATION WIRED BY:
DOWNER
;/-J ELECTRICAL CONTRACTOR
Credit Card Holder Name: /1?~ AN AI ..:S'n9A!:T - ~
Billing Address: PC, ~()~ -(,/0 City: ~Jt!.C:.
.
Exp. Date:
Zip: 98 ~vI
VlSA.:.X. MC: _
PROJECT ADDRESS:
3'-\--1'8 Vvli II CreeK C'CYtdr
Check all that apply: }\'New 0 Alteration/Addition
TYPE OF WORK:
'l2 Residential 0 Multi-family 0 Commercial 0 Mobile Home Sq. Ft
o Remote Meter 0 Detached garage 0 Hot Tub 0 Swim Pool )('i Septic Pump 0 Low Voltage 0 Telecom. 0 Sigl
Number of Circuits added or altered: (:2') II :s \! 20c'-""-f
DESCRIPTION OF THE ELECTRICAL PROJECT: eff llU.-fl.;t- r""f a..r0.. Q;(CC( f'\A.. . tD l-A f 11'i:>1lLu_cd
to fU.,'V'f to M-e CA 'fl.,\ rVv:u..t----
Electrical Heat Load Additions and or Subtractions
Service Information
o Baseboard
o Furnace
o Heat Pump
o Fan-Wall
_KW
KW
TON
KW
LRA
o Overhead Service
o Temp Service
o Underground Service
Voltage:
Phase: 0 1 0 3
Service Size:
Feeder Size:
I hereby certify that I have read and examined this application and know that same to be true and correct, and I an
authorized to apply for this permit. I understand it is not the City's legal responsibility to determine what permits
are required; it remains the applicants responsibility to determine what permits are required and to obtain such.
Credit Card Holder's Signature:
Owner or Elec. Gon1. Signature:~I\,'la-Vtj (LN\.
Date:
C:/ElECTRICALPERMIT APPLICATION
04- C~D-.. 'O-'t-<o~
~G0t1A-p Date:jQ/8.!o";,
PERMIT FEE: $1 t/~ _ 7D
.