HomeMy WebLinkAbout610 S D St - Building
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FOR OFFICIAL USE ONLY:
Date Rec.:
Pennit N: 7 ~ .... (.
Date Approved:
Date Issued: R / J / i'l1
ELECTRICAL PERMIT APPLICATION
The Electrical Permit Application must befllled out completely.
Please type or print In Ink. Uyou have any questions, please call (360) 417-4735
Fax number: (360) 417-4711
/iP5 Ckcie,C4/ Phone: ~S-2.~c,7.>3
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City:
License #:
Pax #
Applicant and/or Agent:
Property Owner:
Address:
Contractor
Address:
Phone:
Exp:
Zip:
Phone:
Zip:
City:
Credit CardHolder Name: sit C~1/ 12..
Billing Address: .5''1 b &~u.>.t!)tV IZI.
Credit Card Number
VISA_MCX-
.
PROJECT ADDRESS:
LEGAL DESCRIPTION: Lot:
to /0 S;c
,
L)
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 on WAC 296-46-910
BRIEF DESCRIP1:ION OF THE PROJECT:
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Electrical Heat Load Additions
Service Information
o Baseboard
o FJIl'nace
~eat Pump
CU8l(.: Wall
KW
_KW
_KW
~KW
o Riser
o Overhead Service
o Temp Service
o Underground Service
I '0
Voltage: [2 ~ -z. '-I'
Phase: &1 0 3
Service Size: ?- '" 0
Feeder Size:
Comments:
I hereby certify that 1 have read and examined this application and know the same to be true and comet. and 1 am authorized to apply
for/his permit. 1 understand it is not the City's legal responsibility to determine what permits are required; it remains the applicant's
responsibility to determine lWlat permits are required and to obtain SU~, J . J
PW.'I02_23 [moJ/.OO] Credit Card Holder's Signature: ~ R ~.l' Date: 5-;(3-010:10