HomeMy WebLinkAbout1612 E 2nd St - Building
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FOR OFFICIAL USE ONLY:
DAte Rcc.:
Pennit#:
Date Approved:
Date blued:
ELECTRICAL PERMIT APPLICATION
The Electrical Permit Application must he filled out completely.
Please type or print in ink. If yon have any qnestions, please call (360) 417-4735
Fax number: (360) 417-4711
Applicant and/or Agent: :f]oh's :!-kc'kic..Jvc., Phone: 9'S7~Gg.j'7 Fax# ;lsz' 9?9'J'
Property Owner:
Address:
Phone:
,:
Contractor
City:
License #:
City:
Exp:
Zip:
Phone:
Zip:
Address:
Credit Card Holder Name: c.FYR. oL Gd:J2- /
Billing Address: ..202 9,~ D$"r;e (.Jme k. R c:I. CitY. 84/lnp:J.!. Zip: ttJ".i'6 i:....
Credit Card Number ~ VISA X MC_
Permit Fee: VS-.'s{.J
PROJECT ADDRESS:
LEGAL DESCRIPTION: Lol:
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E
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ZONING
Block:
Subdivision:
CLALLAM COUNTY PARCEL NUMBER:
TiE OF WORK:
,/ Residential 0 Multi-family 0 Conunercial 0 Mobile Home
Elcctrical Permit fees are based on WAC 296-46-910
BRIEF DESCRIPTION OF THE PROJECT:
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Electrical Heat Load Additions
Serviee Information
o Baseboard
o Furnace
o Heat Pump
o Fan-Wall
KW
KW
KW
KW
o ~ser
o Overhead Service
o Temp Service
o Underground Service
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Voltage: 0- 0 ( Z
Phase: s'l 03
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 / am 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 applicant's
responsibility to determine what permits are required and to obtain such.
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