8296 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LD1 NG PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT , A
Z / BUILDING -ELECTRICAL-PLUMBING-MECHANICAL ' {e
O.NER'S- ,/ PLAN CHECKYACIDATION
• NAME To wo ec," f�-$t O�- OTY. ELECTRIC PERMIT FEE
ry°ME"Ac*ons Z81 $bUTLETS-SWITCHES-RECEP 10.00/1.00
c I .rvo. LIGHTI NG FIXTURES 10.00/1.00
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
ADDRESS 327-Z`1 b
1 PH a PANELS 10.00
S'S DATE OF APPLICATION'
PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
4TJt•INEER
LIC.No. SIGNS TRANS. 3.00
ARDW OR EN SPECIAL CIRCUIT S.QQ PER MIT VALIDATION
zl EMP. METER OR POLE INS. 20.00
APPuc rvrs MOTORS I SEE FEE SCH.
AOO
j SERVICE CHANGE 20.00
M
o LICENSIiDCONTRA ']'ORSDECLARATION TEMP.POLE 30.00
a u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
mz a (commencing with Section 7000)of Division 3 of the Business and
a BLDG. ELECT. PLG. MECH.
H w i Professions Code,and my license is in full force and eff ct.
oi w o License Class._A7 Lic.Numbera�_( s_�_ - El
H w H J Dal, P Con for
a y E J
tc a OWNER-BUILDHR DECLARA ION 14-0+ 45 BUILDING PERMIT
o a u INFORMATION
F
3 LL H 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
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