09895 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
DDR Ess
%\ slE�,��s �� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 09895
IS .OWNER'S /=(f�Q"�. 0 PLAN CHECK VALIDATION
"Ams LT ^, /�f}i'+'G 76 OTV.. ELECTRIC PERMIT` 8Efi+1
PHONE
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CONTRAC OF
/JUTLETS-SWITCHES-RECEP 70,00/1.00
LIGHTING FIXTURES 10.0017.00
cONTRACTORs APPLIANCES-RESIDENTIAL 4.00
ADDRE s
P D PRONE 1PANELS 10.00 DATE OF APPLICATION
OFCHI ECT PANELS (OVER 200 AMP) 20.00 PLANCHECK FEE .C.NO.
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ARCH.OR ENG, PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00
ZIP EMP.METER OR POLE INS. 20.00
ADDRESS
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AMOTORS SEE FEE SCH.
DRE55
SERVICE CHANGE 20.00
o o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
u I hereby affirm that 1 am licensed under provisions of Cha ter9 • /
3 P P ISSUANCE DATE
y Q a- (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F w i Profess
ense Cliona
s Tense is in full force:Iy heffect 1-1 El1:1o m 0 LicLin.Numbs�4L,
Date - Contractor
fO
Y s BUILDING PERMIT
¢ ¢ OWNER-BUILDER DECLARATION
o iINFORMATION
g LL n I hereby uf1'irn that I um exempt from the Contractor's License MISC.- REFER TO ORD
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