469 ATLANTIC BLVD ELPP24-0057 LIGHT FOR PARKING LOT /------11,-vi-f.,, ELECTRICAL PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
'` Cityof Atlantic Beach BuildingDepartment PERMIT# C L P P z �C7(7��'
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// 800 Seminole Road, Atlantic Beach, FL 32233 -`ALL information required to process
�c 2- Phone: (904)247-5826 Email: Building-Dept@coab.us
JOB ADDRESS 40 kt 1k.ic Iv D PROJECT VALUE $ 14+5-0o
JEA INFORMATION REQUIRED ON ALL PERMITS: AMPS ZOO VOLTS 2L) Q PHASE
❑ NEW SERVICE: ❑ Overhead ❑ Underground ❑ Underground up Pole
❑ Residential (Main) Service:
❑ 0-100 amps ❑ 101-150 amps ❑ 151-200 amps ❑ amps #of Meters
❑ Commercial (Main) Service:
E 0-100 amps ❑ 101-150 amps ❑ 151-200 amps ❑ amps ❑CT Service amps
Conductor Type Conductor Size
❑ Multi-Famil (Main) Service:
❑ 0-100 amps ❑ 101-150 amps ❑ 151-200 amps ❑ amps #of Unit Meters
❑ TEMPORARY POLE: amps
❑ SERVICE UPGRADE: ❑ amps ECT Service amps
❑ NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.):
❑ 100 amps ❑ 150 amps ❑ 200 amps ❑ amps ❑ CT Service amps
❑ ADDITIONS, REMODELS, REPAIRS, BUILD-OUTS, ACCESSORY STRUCTURES, ETC:
Outlets/Switches: 0-30 amps 31-100 amps 101-200 amps
Appliances: 0-30 amps 31-100 amps 101-200 amps
A/C Circuits: 0-60 amps 61-100 amps
Heat Circuits: #circuits @ kw #of Lighting Outlets, Including Fixtures:
❑ OTHER ELECTRICAL PROJECTS
Generator ❑ Whole house (ATS) or ❑ Stand alone ❑ Swimming Pool ❑ Sign
❑ FIRE ALARM SYSTEM (Requires 1 set of digital plans):
Quantity volts/amps
❑ REPAIRS/MISCELLANEOUS:
❑ Replace Burnt/Damaged Meter Can ❑ Safety Inspection ❑ Panel Change ❑ OH to UG
❑ Other: I,')S ,i , Ya L� CivtA C1c -}-S
NOTICE: Permit becomes expired if work does not commence ithin a six month period or work is suspended or abandoned for six
months. All provisions of laws and ordinances governing this work will be complied with whether specified or not. The permit does not
give authority to violate the provisions of any other sta r local law regulation construction or the performance of construction.
PROPERTY OWNER Name ; 1 am o IA ecI A E'S- -q- Phone
ELECTRIC COMPANY Name p V',;, rlLc. f Phone goy-707-2.y
Address 7k, 3 /9.,". City citk,q(cS /7 V;I ( State EL Zip 522( g
License Holder ,t� V State Certification/Registration# Vic_ / 3 0c) (:,
"In lieu of signed, sworn and notarized signatures of the property owner, agent and/or contractor, and under penalties of
perjury, I declare tctir I have r-aEand examined the foregoing application and that the facts stated in it are true and correct."
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SIGNATURE OF CO TRACTOR R PRINT OR TYE NAME OF CONTRACTOR DATFI
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