Fillable ELC-1 Electrical Permit Application2 ELC-1_Electrical_Permit_Application2

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ELC-1 Electrical Permit Application2 ELC-1_Electrical_Permit_Application2

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BROWSE CITY OF LACEY (WA) FORMS

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CITY OF LACEY
Co
mmunity and Economic Development Department
420 College Street SE
Lacey, WA 98503
(360) 491-5642
CASH OR CHECK ONLY PLEASE
ELECTRICAL PERMIT APPLICATION
Type of Permit (check one): ( ) Residential ( ) Commercial
Project Address __________________________________________________ Parcel Number ______________________________
Lo
t Number ______________________ Subdivision ________________________________________________________________
Building Area (Sq. Ft.) 1
st
floor ___________ 2
nd
floor ___________ 3
rd
floor ___________ Garage ____________
If
the application is for a low-voltage fire/burglar alarm, will there be a central station monitor? ( ) Yes ( ) No
Owner ______________________________________________________________ Phone Number ________________________
Ad
dress ______________________________________ City ______________ State _________ Zip Code ___________________
Contact Person _____________________________________________________ Phone Number ________________________
Ce
ll Phone __________________________ Fax Number ______________________ E-mail _______________________________
Ad
dress ______________________________________ City ______________ State _________ Zip Code ___________________
Scope of Work:
please also fill out the checklist on the back of this sheet if applicable
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Contractor _________________________________________________ Phone _________________ Fax ________________
Address ____________________________ City _______________ State ______ Zip _________ E-mail ___________________
Contractor’s License Number ____________________________ Expiration _________ City Bus. Reg. ______________________
I
hereby certify that the above information is correct and that the construction on, and the occupancy and the use of the above-
described property will be in accordance with the laws, rules and regulations of the State of Washington.
________________________________________________________ ________________________________________
Applicant’s Signature Date
___
_____________________________________________________
Print Applicant’s Name
FORM: ELC-1
click to sign
signature
click to edit
COMMERCIAL:
______ NEW C/I SVC/FDR 0-10
0
__
____ NEW C/I SVC/FDR 101-200
__
____ NEW C/I SVC/FDR 201-400
__
____ NEW C/I SVC/FDR 401-600
__
____ NEW C/I SVC/FDR 601-800
______ NEW C/I SVC/FDR 801-1K
__
____ NEW C/I SVC/FDR OVER 1K
__
____ NEW C/I ADD FDR 0-100
__
____ NEW C/I ADD FDR 101-200
__
____ NEW C/I ADD FDR 201-400
______ NEW C/I ADD FDR 401-600
__
____ NEW C/I ADD FDR 601-800
__
____ NEW C/I ADD FDR 801-1K
_
_____ NEW C/I ADD FDR OVER 1K
__
____ ALT C/I SVC/FDR 0-200
______ ALT C/I SVC/FDR 201-600
__
____ ALT C/I SVC/FDR 601-1000
__
____ ALT C/I SVC/FDR OVER 1K
__
____ C/I ADD/ALT CIRCUITS 1-5
__
____ C/I ADD/ALT CIRCUITS 6+
______ THERMOSTAT
__
____ YARD POLE, PEDESTAL, LOOP
__
____ TEMP POLE 0-60
__
____ TEMP POLE 61-100
__
____ TEMP POLE 101-200
______ TEMP POLE 201-400
__
____ TEMP POLE 401-600
__
____ TEMP POLE 601+
_
_____ GENERATOR ( ) largest feeder ( ) additional feeder
______ 0-100
______ 101-200
______ 201-400
______ 401-600
______ 601-800
______ 801-1000
______ 1001+
RES
IDENTIAL:
______ ALTER 0-200
_
_____ ALTER 201-600
__
____ ALTER 600+
__
____ ADD/ALT CIRCUITS 1-4
__
____ ADD/ALT CIRCUITS 5+
______ RESIDENTIAL GENERATOR
_
_____ OUTBLDG/DET GARAGE W/ SVC
__
____ OUTBLDG/DET GARAGE – SEPARATE
_
_____ SWIMMING POOL W/ SVC
_
_____ SWIMMING POOL – SEPARATE
__
____ HOT TUB/SPA W/ SVC
______ HOT TUB/SPA – SEPARATE
__
____ RES METER/MAST REPAIR
_
_____ YARD POLE, PEDESTAL, LOOP
_
_____ TEMP POLE
FORM: ELC-1
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ELC-1 Electrical Permit Application2 ELC-1_Electrical_Permit_Application2

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Completed 13 July 2020

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