9480 APPLICANT TO FILL IN INFORMAT WITHIN RED LINES - USE BALL POINT PEN ONLY
BUI LDI NG PROJECT I DENTI FICATIO PERMIT NUMBER
BUILDING APPLICATION & PERMIT 9480
aoDRE
iJILDING - ELECTRICAL-PLUMBING-MECHANICAL
Ow ER'S PLAN CHECK VALIDATION
NaM CITY. ELECTRIC PERMIT FEE
PHONE
Co TRACT Rs OUTLETS SWITCHES-RECEP 10.00/1.00
NAME 05
1
l/�p�j ��C. I.C.NO. 7/J ✓K O
I/ ffi LIGHTING FIXTURES 10.00/1.00
1CONTRACTORS eADOREas J` (J7�J APPLIANCES-RESIDENTIAL 4.00
A p
fie PRONE? 7--0767 PANELS 10.00 DATE OF APPLICATION 9
`
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NQ
R
ENGINEER
LIC.NO, SIGNS TRANS. 3.00 )-
AARCH.OR DDRESS ENG. '3 SPECIAL CIRCUIT 5,00 PERMIT - Jpagtev
ZIP rrEMP.METER OR POLE INS. 20.00
ASS MOTORS SEE FEE SCH. AUG 14 1985
ADDRESS Ess
SERVICE CHANGE 20.00 p
Se o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 CI Of CUp2►fln0
H¢ u� I hereby affirm that I am licensed under provisions of Chapter 9 ISS ANCE DATE
°i I'e'ommennn with Section 7000)of Division 3 of the Business and
a u 5 BLDG. CT. PLG. MECH.
H o i.� Professions Code,and my license is in full force' effect ❑ ❑ O
z o rn - License Class Lic.Number 0�
o � H w
Dale - Contractor
a a E BU LDING PERMIT
a o a u OWNER-BUILDER DECLARATION FORMATION
w0
LL H 1 hereby affirm that I am exempt from tire Contractor's License MISC.- REFER TO ORD
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