APPLICATION FOR ELECTRICAL PERMIT
ADDRESS
NSEW
STREET #
PERMIT #
STREET NAME
AV,RD,ST etc
SUITE/UNIT(S)
TAX JURISDICTION
PROJECT / OWNER
PROJECT/SUBDIVISION NAME
PHASE
OWNER/TENANT
SECTION
ADDRESS
CITY
STATE
ZIP
PHONE #
LOT #
TAX PARCEL #
# UNITS
TITLE INSURANCE COMPANY / LIEN AGENT NAME
EMAIL
LIEN AGENT PHYSICAL
ADDRESS
STATE
ZIP
PROJECT #
LIEN AGENT MAILING
ADDRESS
PHONE #
JOB #
FAX #
JOB DESCRIPTION:
USDC #
STATE
ZIP
TYPE OF BUILDING
EQUIPMENT
PROPERTY USE
CONTRACT COST $
CONTRACTOR
CONTRACTOR NAME (as licensed)
PHONE #
ADDRESS
CONTRACTOR #
LICENSE #
BONDED WITH CODE ENFORCEMENT ?
ZIP
STATE
CITY
TYPE OF LICENSE
YES/NO
TYPE:
OTHER
UTILITY COMPANY
ITEMS INSTALLED
CODE DESCRIPTION
REMARKS:
QTY
CODE DESCRIPTION
HEATING/AC
APPLIANCES
QTY
CODE DESCRIPTION
HEATING/AC - Cont.
001 CLOTHES DRYER
031 AIR FILTER
053 HUMIDIFIER
003 COOK TOP
033 BASEBOARD HEATER
055 ROOM AC UNIT
005 DEEP FAT FRYER
035 BOILER-ELEC, GAS, OIL
057 UNIT HTR - ELEC, GAS, OIL
007 DISHWASHER
037 CENTRAL AC
059 WALL HEATERS
009 DISPOSAL
039 CHILLER
011 GRILL
041 COOLING TOWER
071 ATTIC FAN
013 OVEN
043 DUCT HEATER
073 CONTROL WIRING
015 RANGE
045 DUAL FUEL HEAT/AIR UNIT
075 GARAGE DOOR OPENER
017 W H - TANKLESS
047 FURNACE-ELEC, GAS, OIL
077 HOOD EXHAUST FAN
019 W H - TRADITIONAL
049 HEAT CABLE
079 MOTORS
021 W H BOOSTER
051 HEAT PUMP UNIT
081 SEPTIC PUMP
MOTORS AND CONTROLS
PAGE 1
QTY
CODE DESCRIPTION
QTY
QTY
CODE DESCRIPTION
MOTORS AND CONTROLS - Cont.
CODE DESCRIPTION
GENERAL USE
083 WELL PUMP
161 FIXTURES
SERVICES AND FEEDERS
201
163 FLOOR DUCT
FT
201
101 CATV SERVICE
165 LIGHTING STANDARD
103 FEEDER, CONN, TOT. AMPS
167 MULTI-OUTLET ASSN. FT
105 L.C.D
169 OUTLETS
107 METER, C.T. CAN
171 POWER POLE (OUTLET)
109 POLE SERVICE
ELECTRIC VEHICLE 120 VOLT CIRCUIT
201
111 SAW SERVICE
ELECTRIC VEHICLE 240 VOLT CIRCUIT
201
201
201
201
201
MISCELLANEOUS
113 SERVICE, TOT. AMPS
191 CONST/TRAILER-INSIDE
ELECTRICAL SERVICE UPGRADE
SPECIAL EQUIPMENT
QTY
USE BLANK SPACES FOR OTHER ITEMS
997
FIRE DAMAGE
999
DOUBLE FEE
193 HOT TUB, SPA
131 BILLBOARD SIGN
195 MODULAR UNIT-INSIDE
133 ELECTRIC SIGN
197 PHONE BOOTH
135 GASOLINE DISPENSER
199 SWIM/POOL BNDG GRNDG
137 GENERATOR
201 FIRE ALARM/ LOW VOLTAGE
139 TIREMOLD
203 LV LOCKING OF EGRESS
141 TRANSFORMER
205 LOW VOLTAGE - NOT FIRE
QTY
DOORS
ALARM
143 VACUUM UNIT
METHOD OF PAYMENT
CASH/CHECK
ACCOUNT
APR'D
TOTAL $
THE UNDERSIGNED HEREBY CERTIFIES THAT HE/SHE IS EITHER THE OWNER OR THE AUTHORIZED AGENT OF THE OWNER AND HEREBY MAKES APPLICATION FOR
PERMIT AND INSPECTION OF WORK DESCRIBED AND AGREES TO COMPLY WITH ALL APPLICABLE LAWS REGULATING THE WORK.
DATE
APPLICANT'S SIGNATURE
MECKLENBURG COUNTY LAND USE AND ENVIRONMENTAL
SERVICES AGENCY
P.O. BOX 31097 CHARLOTTE, NC 28231-1097 ... 704/336-3837
HOLDS
PRINT APPLICANT'S NAME
PROCESSED BY
APPROVED BY
VALIDATED BY
ADDITIONAL COMMENTS
PAGE 2
REV - 7/24/2014