8159 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
XBUILDING PROJECT I DENTIFICATI ON PERMIT NUMBER
BUILDING 'APPLICATION & PERMIT
ADDRESS 9 59
BUILDING - ELECTRICAL-PLUMBING -MECHANICAL
XDINNER PLAN CHECK VALIDATION
NAME f s _ OTY. ELECTRIC PERMIT FEE
PHONE
corvi Across UTLETS SV
10.00!1.00
NAMF
LC.No. LIGHTING FIXTURES 10.00/1.00 '
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
ADD NESS
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
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ENGINEER a
uc.No. SIGNS TRANS. 3.00
ARCH,OR END SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
SS
ZIP TEMP. METER OR POLE INS. 20.00
ADDRESS is MOTORS SEE FEE SCH.
APELICA
SERVICE CHANGE 20.00
w 0 2 LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
u u I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
yi Professions Code,and my license is in full force and effect. El El El
0 w - License Class Liu.Number
9 m Date - CootrtuR r ,
x in 4 OWNER-BUILDER DECLARATION BUILDING PERMIT
w U INFORMATION
w3 A N I hereby affirm that 1 am exempt front the Contractor's License MISC.- REFER TO ORD
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