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FEE RECEIPT NUMBER
CITY.OF' PO,RT ANGELES
DEPARTMENT OF LIGHT
APPLICATION AND ELECTRICAL PERMIT
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PERMIT N~MBER
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. TOTAl FEE
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CONT. Lie. NO..
TIME TO COMPLETE
NO. STORIES
LEGAL OCCUPANCY
ELECTRICAL PERMIT ONLY
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NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT
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PERMITS WITH WRONG ADDRESSES ARE CA CELLED
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Owner Installation By
Owner's Address .i=J 3' Installers Address
Day Phone I.J 57 '?"'5-cq <;-. Installers Phone
Application is hereby made for Permit to install Electrical Equipment as follows:
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Wiring Method'W?e
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NUMBER AMP 120V 24QV NUMBER AMP 120V 24QV
USE OF CIRCUIT PER 100R FEE USE OF CIRCUIT PER 100R FEE
CIRCUITS CIR 10 30 CIRCUITS CIR 10 30
LIGHT SIGN
50 VOLTS ,. "
LIGHT OR lESS
CONVENIENCE - , --- MOTOR .
CONVENIENCE - MOTOR -
APPLIANCE . MOTOR . ,
DISHW~ASHER . FIRE ALARMS
DISPOSAL BURGLAR ALARM
RANGE MISC.
OVEN
WATER HEATER
LAUNDRY - ..
DRYER REINSTALLATION LIGHT FIXTURE #
FURNACE SUB TOTAL FEE ; . ,
GAS - OIL
FURNACE ENERGY FEE
ELECTRIC .
BASIC FEE .
ELECTRIC HEAT . , - .'
TOTAL FEE
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ELECTRIC HEAT . SIZE OF SERVICE. SWITCH OR CIRCUIT BREAKER
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A.C. UNIT 'Iv f ,I ~ I-
AMP PHASE
FEEDER 7- 1"1 (,'f Nt '11I."". 1/l/ SIZE OF SERVICE ENTRANCE CONDUCTORS
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SERVICE A.W.G.
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SIZE OF GROUND SIZE OF ENTRANCE SWITCH
I certify that the work to be
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it ;"ill be done by the Installer and in conformance with the N.E.C. Electrical Code.
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CONTRACTOR OR OWNER (0 AUTHORIZED AGENT)
Permis~io(1.is hereby.given to ~o.the above des.cribed work, according to the conditions hereon and according to the' approved plans and
specifications pertaining thereto, subject to compliance with the Ordinances of the Clt of Port Angeles.
. . IRE R OF CITY LIGHT
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Date Application made I.
3/19/0&
Notify Department of City Light by Street Address and ermit Number when ready for inspection. Work must not
be cover!t.d or current turned on before inspection and O.K. for covering, or service has been given by Inspector in'
Writing on Permit Placard. A. . Permits Phone: 457.0411 Ext. 158.
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Date Permit Issued
WARNING
PERMIT PLACARD MUST BE KEPT POSTED ON THE WORK - SEE OVER -
WHITE. OrIginal CANARY. Duplicate PINK. Triplicate WHITE CARD. Inspector's Report
QL YMPIC PRINTERS, INC.
REPORT OF INSPECTOR
DATE OF VISIT MADE BY REMARKS
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')/ VV/'rr. O.K. TO CONNECT SERVICE
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