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APPLICATION AND
<br />ELECTRICAL PERMIT
<br />(TYPEWRITE OR PRINT IN INK)
<br />O.'."or'ANrAANA
<br />20 CIVIC CENTER PLAZA
<br />834-4186
<br />o
<br />APPLICANT FILL IN AREA BETOW
<br />@c
<br />Izo
<br />oI
<br />2a 3z .5JOBAOOiESS
<br />{o.E CH
<br />4... Hor.l., Ior.l., Apr. Sa Fr 03
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<br />MATLTNGADoRESS
<br />B.c.9r.cr.. €--a---I 50
<br />= lc.("-+qlY STATEI'IP
<br />50
<br />E.cn
<br />20 00
<br />ADDrovad Fado.y wnld Unn 500
<br />&l.*aya, apaciar racarqn, uiOar ioo. oud,
<br />tollay o, Pluo-in bu!*rya aa im'500
<br />frl. li(rn.hne sllbm Minrmum i..olrld .,nol. o. rt..r r.rBo.
<br />!0 00
<br />50
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<br />E.ch Addl nnur. o. llma aocliard
<br />500
<br />r00
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<br />lrE. rrs ftr tur6d doL6 r!600r
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<br />u.'nl.nrncr Pfimrl la^nuar)50 00
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<br />'S--q-ql-? - I \t
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<br />Ora, 400 ampa. par ma!,
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<br />35 00
<br />75 00
<br />s'g.r .nd h'gh poLnl[r 9r! lub. rrghing r500Itott.--*--.-
<br />ADbAESS
<br />SrmmnC aooll, lounrana. aprt 35@
<br />a..-. ^ F ^--
<br />CITY e 1x{ek
<br />r500
<br />Srnch!o.6, hoio. cont.or c.ntcr o. aut,pancL
<br />Erch
<br />Tampo.rry conarrudlo'l marar ac*rca 9olc
<br />E.ch dlrtrDutlon por.
<br />15 Cro
<br />3.00
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<br />t-')c crY
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<br />200
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<br />FOWER APPAnAIUS G!n.r.ror.. rlloro,r
<br />lranalo.mafl, rentar., i^duatrrl h.rling,
<br />cootlnC, or ta*rng.quipm. .nd olh.r
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<br />Up to and rhcluo'ng I HP, xw, Kva
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<br />Ov.r 50 .,id nor ov.l l0O HP. KW XVA
<br />Ov.r 100 .nd nol oYr 50O HP, XW, ruA
<br />Ov.r 50{ HP. xw xv^
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<br />Panrlty F.. (rhan applcabl')
<br />vior.ion F.. tmin,hum 335 00)
<br />Plr6 Ch.ck F.c llnrnimuh 31500)
<br />nacdpr No- PC
<br />10 00
<br />IOIAL PliIlT FEE (Dh.mum 335 00)3<'E
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<br />OATE lo,/1 t /+<'PEiIIT I'O l97E
<br />PEAMII TSSUTOBYISR ,t=BUltollrlc
<br />PERMITI{o VIFIFIEOBYISI!
<br />.,s A I R 3 q IVALIOAT|oN IOFfICT USE ONLY)
<br />Drsrribulion I lnsp€cror Copy 2 Filecopy 3 Frnancocopy 4 Appllcantcopy
<br />k_E Rcrdont,rt E rndusr,rrl El co.rncrc,a,TOIAL
<br />300
<br />2.00
<br />500
<br />r0.00
<br />20.00
<br />$.00
<br />tlo.00
<br />35000b P3138
<br />L'c.n.-
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