4550 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 4550
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BUILDING — ELECTRICAL—PLUMBING-MECHANICAL
OWNER'S — - - PLAN CHECK VALIDATION
NAO� Cl/_ QTY. ELECTRIC PERMIT FEE
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CONTRACTOR, s UTLETS-SWITCHES-RECEP 5.00/1.00
D. LIGHTING FIXTURES 5.00/1.00
CONTRACTOR
S PPLIANCES-RESIDENTIAL 4.00
MI V PeoNE 'PANELS - 5.00 DATE OF APPLICATION
ARCHITECT
SIGNS B.00 - PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.NO. SIGNS TRANS. - 3.00
ADDRESS urea SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
➢P TEMP,METER OR POLE INS. 15.00
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ADoRSsnrs "'W19 SERVICE
- SEE FEE SCH. -
SERVICE CHANGE 10.00
w o o LICENSED'CONTRACIFWS DECLARATION
G u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUAN(((CE(DATE
maw (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. E
F y z Professions C C.u license is in full f ❑ ❑ ❑
41.
z o u, — Licen la sec.Numb•
o r Date Lic int
Q y J
a s w a owNli R-Bea DER DEC n nnON - BUILDING PERMIT
a. " MISC.— REFER TO ORD INFORMATION
w u n 1 hereby affirm that I am exempt from the Contractor's License VALUATION
u o j Law for the following reason,(Sec.7031.5,Business and Professions S/PT.
• — PERMIT ISSUANCE 6.00
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