1020 }APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ON
." BUILDING PROJECT IDENTIFICATION .. PEH N MRER
BUILDING : APPLICATION.& PERMIT
1020
ADOREss
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
ERS PLAN CHECK VALIDATION
""M QTY. ELECTRIC PERMIT FEE
ANIATONE
NA
CONTRACTORS - )USZ_ UTLETS-SWITCHES-RECEP 5.00/1.00 -
NOME
uc.NO.
' LIGHTING FIXTURES 5.00/1.00
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE - PANELS 5.00 DATE OF APPLICATION
ARCHITECT SIGNS ' 6.00 PLAN CHECK FEE P.C.NO,
OR
ENGINEER
' uc.No. SIGNS TRANS. 3.00
ADDRESS E"G' SPECIAL CIRCUIT 5,00 PERMIT VALIDATION .
ZIP EMP:.METEROR PO 15.00
APPLICANT'S MOTORS EE SCH.
ADDRESS
SERVICE`C GE hD 10.00
woo LICENSED CONTRACTORS DECLARATION C'
< I hereby affirm that I am licensed under provisions of ChapteD9 t SUANCE DATE
u' from merem,with Section 7000)of Division 3 of the Business and BLDG. LECT. PLG. MECH.
G z Professions Code,and at,license i,,i,full force and effect
o 0 m W License Class Lic.Number _ ElI]
Dale Contractor
BUILDING PERMIT
¢
OIL
K , OWNER-BUILDER DECLARATION _s,' INFORMATION
AOA ° MISC.- REFER TO ORD
w S F. r I hereby affirm that I ant exemprom t fthe Contractor's License VALUATION S/FT.
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