8460 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
ANG APPLICATION & PERMIT
ADDRESS d i55 1'f V+
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
8460
Ow E PLAN CHECK VALIDATION
NAME N�HONE OTY. ELECTRIC PERMIT FEE
•
NAM[RAcroR UTLETS-SWITCHES-RECEP 10.00/1.00
G/ UC.N0, LIGHTING FIXTURES 10.00/1.00
ADDRESS r APPLIANCES-RESIDENTIAL 4.00
_ PHONE PANELS 10.00 �l DATE OF APPLICATION
ORCH E T PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.N0.
ENGINEER
uc.No. SIGNS.TRANS. 3.00
ADDRESS ENc' SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
APPLICANT'S MOTORS SEE FEE SCH. /N'L
ADDRESS �
SERVICE CHANGE 20.00
woo LICENSED CON'TRACT'ORS DECLARATION TEMP.POLE 30.00 /LJ
m o I hereby Minn that 1 am licensed Order provisions of Chaplet 9 ISSUANCE DATE
n4 enci
m (commng with Section 7000)of Division 3 of the Business and
H n z Professions Code,and my license is in full force and effect BLDG. ELECT. PLG. MECH.
❑ ❑ ❑
z o rn License Class_�f�_Lie.Number /a[M-29 .,
mt wo Date . f� Contractor �
OWNER-BUILDER DECLARATION T BUILDING PERMIT
W U INFORMATION
w;e w 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
H LL6oj