C9424 t
APPLICANT T FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FICXiION PERMIT NUMBER
\1, BUILDING APPLICATION & PERMIT /1 , 9424
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BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
xx ' OWry R'S PLAN CHECK VALIDATION
X rvAME TY. ELECTRIC PERMIT FEE
. .1 PHONE �O
Ncr R -"
AME OUTLETS-SWITCHES-RECEP 10.00/1.00
LIC,No, LIGHTING FIXTURES 10.00/1.00
r-DNTRAcroRs PPLIANCES-RESIDENTIAL 4.00 -7J
ADDRESS
T_ PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER LOC.NO. SIGNS TRANS. 3.00
ARCH.
RENG, SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ADDRESS
ZIP EMP. METER OR POLE INS. 20.00
A 1 MOTORS SEE FEE SCH. PA,�D
ADDDRESSDRESS
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A SERVICE CHANGE 20.00 AUG
O o LICENSED CON'T'RACTORS DECLARATION
TEMP.POLE 30.00 U 161965
I hereby affirm thin I am licensed under provisions of Chapter 9 evASSULANGE DATE
1 w w (commencing with Section 7000)of Division 3 of the Businessand BLDG. �Qe In MECH.
Q A
H N i Professions Code,and my license is in full force and effect. ❑
y 0 o w - License Class Lie,Numbers
o y H w Dutc Contractor ` �' f
a y f 1 BUILDING PERMIT
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OWNER-BUILDER DECLARATION INFORMATION
w0 u N I hereby affirm that I am exempt from+the Contractor's License MISC.- REFER TO ORD
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