1600 Selva Marina Drive COMM18-0014 (Application) ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach,FL 32233
Ph(90t4]-5826 Fax(904)247-5845 W/�/� /g'"60l z
JOB ADDRESS: t(SOU �j mcg-( fl( )r PERMIT# /
JEA INFORMATION REQUIRED ON ALL PERMITS ICO AMPS SLID VOLTS I PHASE
oO
VALUE OF WORK$ l 0 OCA -p
NEW SERVICE E Overhead Underground J Underground up Pole
❑Residential(Main) Service
00-100 amps ❑101-150amps ❑151-200amps amps #of Meters
t mmercial(Main) Service
&100 amps ❑101-150amps ❑151-200amps ❑ _ amps OCT Service amps
Conductor Type Size
❑Multi-Family(Main)Service
00-100 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 OCT Service amps
ADDITIONS,REMODEL,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: 0-3 Damps 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: Ip
OTHER ELECTRICAL PROJECTS
❑Swimming Pool ❑ Sign ❑Smoke Detectors Qty ❑Transformers KVA ❑Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
REPAIRS/MISCELLANEOUS
❑Replace Burnt/Damaged Meter Can ❑Safety Inspection ❑Panel Change .O/to UG
❑Other:
Permit 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
read 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
specified 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
construction. / J1 f �,, ,y�
Property Owners Nam, it _J1f it/ M, f Cull! Phone Number �� /'1 ydLt 1 /
Electrical Company Li Th 71111 0050.146 f �1 Office Phone/NI 1 U ( Fax 1,011
Co.Address: Li Ate Vit- W0 14/3 City State Zip
License Holder(Print): (k( 4 (A •d. State Certification/Registration#a(3D02,Nt6 _
Notarized Signature o ' • - • - - ��) t
BARBARA K.KENN •
17
=4\f ...r .. •scribed bef• - e tz is say of .,. _ ! . A 70 1
. ,.. ;�: MY XP RESSMe�rCh t�i7,2�2 � -
s �,��� E I • �� I _ C..t.
�Pc„< e21ritero 1_.....i.. Bonded Thr ___ ti`y.y _ -� otary Public