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225 FIFTH STREET ;' _:_"":h'~, ~?~':;;g;;;;~",~", ,ELECTRICAL PERMIT APPLICATION
~*~~~~~ 9~i~~3769 ;Z-'?fS_jff)e;;-C[.~f"J~b Number 9"3'/":7 ,~
, jI'I.;<.{, "l\' ..,"." '----: "13 3. '''''COMPLETE FEE SCHEDULE BELOV
1. LOCATION OF,. ,;INSTALLATION ~"iJn::tlJraJ A"""" . .._
~/..r $/// ~w Residential-Single or
LEGAL DESCRIPTION \ 'JD335~ d Oqq()(J' se~~;:~ru~:~: dwelling uni t.
ul!:7tVId;;" ~ 8-C//fc. (/1 7J'.' ", Items Cost Sum
2. CONTRACTOR INSTALLATION ONLY B. Services or Feeders
Installation, Alterations
Electrical Contractor ,.l(fddl CD dKH/C or Relocation:
Address /?i?? /~ 1. 200 amps or less
201 amps to 400 amps
CitY~UI1~ Phone'}'irS'l'/ 401 amps to 600 amps
it I ' /.;'" 601 amps to 1000 amps
Supervisor License Number /r' J.n>/ lJ ~ ~(. l/J'Over 1000 amps/volts
. I
/ Reconnect Only
/C:S//5/ / ~S-
/
Constr Contr. Number n?cr-/?;<C.
Expiration Date " I / ~ II,/'
JOB DESCRIPTION .
$i5 ~IUC~.,r tEKRP/~
Permits are non-transferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
180 days.
Expiration Date
;'
. I ,-
Owners N3;mep_4 - ;/f: /2. c/o n."c
Address f> C 0 ~/ ?:"" Aj' / A""'<:' .
~
City9',L. Phone ?~J-fr2.<rJ.7
OVNER INSTALLATION
The installatiori is beirig made on
property I own which is not intended
for sale, lease or rent.
OWners Signature:
---------------------------------------
DATE: /2'-2 $~::>
RECEIPT t: I/<Y~
RECEIVED BY: ~7~ po
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dwelling
Service or Feeder
$ 85.00
$ 15.00
$ 40.00
~$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
.L"-~ ~
;:::>e. ....
C.
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps
201 amps
Over 401
Over 600
or less
to 400 amps
to 600 amps
amps or 1000
D.
Branch Circuits
volts
$ 40.00
$ 55.00
$ 80.00
see "B"
above
New, Alteration or Extension Per Panel
One Circuit $ 35.00
Each Additional
Circuit or with Service
or Feeder Permit ~ $ 2.00 ~~
not included)
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
E.
5.
SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL '
$
$
$
$
66- dO
":? ...:3t=>
-.6 9. 3tt!>
,
40.00
40.00
20.00
36.00