HomeMy WebLinkAbout07110121 Application/ c`ty OF CAgyF
°PH!" City of Carmell Towns
n APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE FAX
CONTRACTOR c T In1c. fit} - Z- S9 3t?- 9 L
INFORMATION: sa?cannerms city state ZIP
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NAME CONTACTPHONE:
APPLICANT. A v?t E ctf std -?5z-lv
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL; COMMERCIAL: __x_
PROPERTY OWNER NAME(S): PHONE
PROPERTY -r sF ?E .,ao 3t -&.T2.- v'7
OWNER
INFORMATION:
STREET
ADDRESS:
city State
Zip
330 ,ecx?SEVEt_i JE t?Ar/WA G! lJ? ?G??
STREET ADDRESS (INSPECTION LOCATION): @y state ZJp
INSPECTION 66 30 v E I I sT LRt2?? L Af
INFORMATION:
DATE OF INSPE
TIME OF INSPECTION:
I ! a
Lt -
TYPE-OF'IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O UPGRADE SERVICE: From to
O' UPGRADE PANEL BOARD(S)
O ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN,EXISTING ELECTRICAL DISTRIBUION SYSTEM
NEW METER SERVICE (i.e. Fountain in pond;
SubdiVision street or signage lighting; Installation of
new utility services for an area)
O ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
O CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
O YES K NO
Number of NEW CIRCUITS:
Number of METERS: '-
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLE TTErAND/?CCURATE.
i
PRINT
COMMENTS`or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
two WtC 'S %A.-I->F>L,
SCANNED
FEES:. $104.00 for Commercial Inspections; $ 57.50 for Residential Inspections