Laserfiche WebLink
APPLICATION <br />ELECTRICAL WIRING PERMIT <br />JOB ADDRESS <br />USE OF BUILDI <br />PROPERTY OWNS <br />CONTRACTOR Hon e, R t Lec- 7-krc <br />VALUE OF WORY. (comm.). R ; o ct <br />WORK TO BE DONE: <br />X_ NEW ALTERATION <br />LICENSE NO. Bcj,,Pee Cyty Ry <br />TELEPHONE NO. S-Y6' i, v 9 1 <br />WIRING NUMBER OF CIRCUITS <br />SERVICE NUMBER OF CIRCUITS <br />SIZE <br />FORCED AIR FURNACE <br />BASEBOARD TOTAL WATTS <br />REPAIR <br />REPLACE <br />120V 240V <br />120V 240V <br />AMPS <br />K.W. (MECHANICAL PERMIT <br />ALSO PQUIRED <br />DESCRIBE WORK TO BE DONE <br />I ' <br />F;-ATVKle 7 DuPI-ex -✓I-F eS C-r.c) <br />• � a�, r �, Roo.,., F �- � � L �� �� �, � c.�o ...,b; � � � : a ,.._. <br />i !/l <br />i <br />SIGNED BY ` , DATE `�' / 3 ' b r� <br />DO NOT WRITE BELOW THIS LINE <br />1 <br />NOTES & CM-1ENTS <br />TOTAL FEE 3 <br />APPROVED BY <br />DATE <br />FEE SCIIEDULE ON REVERSE SIDE <br />