T HE CO R PO R AT IO N O F T H E CIT Y O F NO R T H V A NCO U V ER

TH
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ELECTRICAL PERMIT APPLICATION FORM

Site Address: Unit# :

APPLICANT: FEE:
Name:
Address:
City: Province: Postal Code:
Contact Person: Phone:
Fax: Cell: E-mail:

CONTRACTOR CERTIFICATION: Class: #:

Field Saf ety Representative, Name:
Class: #:
Job Name: Job Value: $
Business License #:

Co n st ruc t io n: Ne w  A lt er at i on  P l an s Sub mit t ed : Yes  No 

T yp e of Con st ru ct io n : SF D  Du p lex  T r ip lex  Co n dos /T o wn ho us es 

Com m er c ia l  In d us tr i a l  Ins t it ut i on a l 

T yp e of P e rmi t : Re g ul ar  T em por ar y  A n n ua l  Co n nec te d L o a d:

S erv ic e: New  A lt er at i on  T em p t o Pe r m Co n n ect io n : Ye s  No 
S erv ic e S iz e : Am ps ; V o lts ; P h as e ; W ir es .
M ast e r met e r: Ye s  No  Nu mb e r o f met e rs: 1 P has e : 3 P has e :

L ig hts R ec e p tac l es S wi tc h es Fa ns T her m os t at

S pac e H ea t er s A l ar m s R an g es D is h was h er Fu r n ac e
Dr yer s D is pos a l Un i ts H ot W ater M ot or s

Description of Installation:
As a condition of being granted the permit applied for, I agree to indemnify and keep harmless the City of North Vancouver against all claims, liabilities, judgments, costs, and expenses of
ay kind whatsoever, which may accrue against the City in consequence of, and incidental to, the granting of this Permit. I further agree to conform to all requirements of the Building
Bylaw and all other statutes and Bylaws in the City of North Vancouver. I understand that upon issuance of this permit, work must commence within 6 months, be continued on an
ongoing basis and be completed within 2 years of the permit date.

Applicant Name: P er m it No .: E LE 2 0 -
(Please Print)
Office Use onl y
Applicant Signature: Date:

Please note that making an application or paying a fee does not necessarily imply that a electrical permit will be
i s s u e d . T h e e l e c t r i c a l p e r m i t wi l l o n l y b e i s s u e d wh e n a l l t h e c o n d i t i o n s a n d r e q u i r e m e n t s o f
C i t y b y l a ws a n d c o d e s a r e m e t .