HomeMy WebLinkAbout06060197 Application
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APPLICATION FOR ELECTRICAL rnS!>E'CTION
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FAX
NAME
PHONE
CONTRACTOR
INFORMATION:
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City
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Stale
Zip
Street Address
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APPUCANT
INFORMATION:
NAME
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Property Owner
(or agent) OR
co Acr PHONE:
Contractor -
Representative X
o NEW METER SERVICE (I.e. Fountain In pond;
Subdivision street or slgnage lighting; Installation of
new utility services for an area)
PROPERlY OWNER NAME(S):
TYPE of WORK:
---RESIDENTIAL:
PROPERTY
OWNER
INFORMATION:
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STREET ADDRESS (INSPECTIO OCATION):
INSPECTION L 1 'Z.."O E: Y b4'--
INFORMATION:
Zip
DATE OF INSPE ON:
TYPE OF IMPROVEMENT:
i4.. UPGRADE SERVICE: From <..0
o UPGRADE PANEL BOARD(S)
YES
~ NO
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of NEW CIRCUITS: </
Number of METERS:
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
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Signature
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDectioh location)
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PRINT
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.DATE
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts/FormS/Electrlcal Application AfJr 2006