201 SAILFISH DR - ELECTRIC (-
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� � A CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
•K'♦ } ATLANTIC BEACH, FL 32233
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ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
lJ/1�� 800 Seminole Rd, Atlantic Beach, FL 32233 C.--R� 1 0
( Ph(90k247-5826 Fax (904) 247-5845 d 3
to OB ADDRESS: RQ'^" ` "Sk Vr. A+ B'QOe 5 RMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS ;/ tJl)
AMPS c2 IL. VOLTS / PHASE
VALUE OF WORK$ 0740-°()
NEW SERVICE I I Overhead I I Underground I If Underground up Pole
❑Residential(Main) Service
❑O-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Meters
❑Commercial(Main) Service
❑0-100 amps 0101-150amps 0151-200amps L] amps OCT Service amps
Conductor Type Size
❑Multi-Family(Main)Service
❑O-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Unit Meters
❑Temporary Pole ❑ amps
SERVICE UPGRADE ❑ amps ❑ CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
❑100 amps ❑150amps 0200amps ❑ amps DCT Service amps
kDDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: 0-30amps 31-100amps 101-200amps
Appliances: 0-30amps 31-100amps 101-200amps
A/C Circuits: 0-60amps 61-100amps
Heat Circuits: # circuits @ kw
Number of Lighting Outlets, Including Fixtures:
)THER ELECTRICAL PROJECTS
❑Swimming Pool ❑ Sign ❑Smoke Detectors Qty ❑Transformers KVA ❑Motors hp
IRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
EPAIRS/MISCELLANEOUS
❑Replace Burnt/Damaged Meter Can afety Inspection ❑Panel Change ❑OH to UG
❑Other:
nnit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months. I hereby certify that I have
d this application and know the same to be true and correct. All provisions of laws and ordinances governing this work will be complied with whether
cified or not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of
tstruction.
3perty Owners Name
g/1 Gil-GU n Phone Number 9 Z.3
;ctrical Company C 4illr(a (aNithICII 114C-• Office Phone '2 1-5sq Fax 190'��/40,37
. Address: 2301 (�°�__ tt -- e� �'�-LIL0
/� CityaQ�P C:V] Stat Zip L
e older (Print): �k," k e��'.el State Certification/Registration# F0,56626)(9
. :- . ._ 7: .-' _ '__.__ :_-_.:_ ,lder G"
1211
q �s IVYALKER =
�: ;.1 MYC�LLIANNOGG008111 I;efore me this a day�of Othbbe,r20 11
__N°617 __ _ -I•ignature of Notary Publicq„