9349 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION
PERMIT NUMBER
AUILDINc APPLICATION & PERMIT 9349
DOREss
/997/ BUILDING — ELECTRICAL—PLUMBING—MECHANICAL
Merrrff.Dr�'✓�
OwNER'S PLAN CHECK VALIDATION
'NAME
,'JyEOTY. ELECTRIC PERMIT FEE
IKppQ /WF/ PHONE �% l✓Few
NA�Nj,ERAcrORs OUTLETS-SWITCHES-RECEP 10.00/1.00
HOn9e-.D/.:5C a,7E # C.NO. 3/T l30 LIGHTING FIXTURES 10.00/1.00
.---� cONTRAcrons / �. � , APPLIANCES-RESIDENTIAL 4.00
ADOREss f
3aaC'orn�nercia PHONE a9a�8/d PANELS 10.00 DATE OF APPLICATION
ARCHITECT `B� ,r�.Il PANELS (OVER 200 AMP) 20.0Q PLAN CHECK FEE P.G NO.
OR J N C/
ENGINEER
LIc.NO. SIGNS TRANS. 3.00
ADDRESS cmc. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
ADMOTORS SEE FEE SCH.
ADDRESSDRESS
SERV.POLECHANGE 20.00 /y/ /}/
Fo o LICENSEE,CONTRACTORS DHCLARA'TION TEMP.POLE 30.00 /�7
G v I hereby afm that I am licensed under provisions of Chapter9 ISSUANCE DATE
fir
a,¢ A (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H m z ro Ce#tnDER
s In full fort.. �1�c
i o — icenNumber ❑ ❑ ❑
Q z r Date ntractor
a x BUILDING PERMIT
¢ tc w¢ DT:CLARATION INFORMATION
woAe' MISC.— REFER TO ORD
LL N 1 hereby affirm that 1 am exempt from the Contractors License VALUATION S/FT.
H u o ¢ Law for the following reason.(Sec.703 t.5,Business and Prolcssions PERMIT ISSUANCE 10.00
Code Anycity orcounty which requires a permit to construct,alter,
QIS¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
— O u requires the applicant for such permit to filo a signed statement that TOTAL PERMIT TO
n w re he is licensed pursuant to the provisions of the Contractor's License
rzi