HomeMy WebLinkAbout07120059 Application... - .?;;n: Sze .s,a;ma-.• __.
Citylof Came1X1gy To"ship CAL INSPECTION
APPLICATION FOR ELECTRI
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NAME
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CONTRACTOR -c
INFORMATION: Street Address
APPLICANT / f ra vc?
INFORMATION: - pr6perty Owner
TYPE of WORK:
PROPERTY
OWNER
INFORMATION:
RESIDENTIAL:
PROPERTY OWNER NAME(S):
-$aIG 04 T kex-x'S
STREET ADDRESS:
;e $ o ,erx?SE V EL--T /I
STREET ADDRESS (INSPEMON LOCATiON):
INSPECTION ?Jr 88 ?rv T
INFORMATION:
DATE OF INSPECTION:
TYPE OF IMPROVEMENT:
O UPGRADE SERVICE: From to
O UPGRADE PANEL BOARD(S)
O ADDITION, ALTERATION,: REMODEL, or REPAIR TO
AN EXISTING' ELECTRICAL DISTRIBUION SYSTEM
® NEW'METER-5ERVICE (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)
city
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach man of inspection location)
nl c ?..5 «?$ ? E T J 'F?a v.rc'?+Z ?y.APr- / c->? i? Inr't T -
$E14(i r11 l t l 12RNS(uRt?E2 )[P14 (Z `j 4
O CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
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OR
CRY
city
state LP
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CONTACT PHONE:
3( 9z -752--10
Contractor
Representative
COMMERCIAL:
PHONE
3/? -lo3Z-`?U?
Stit°_ 23P
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star,: ZIP
TIME OF INSPECTION:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O YES )('NO
Number of NEW CIRCUITS:
Number of METERS: J-
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
D
Sigwture
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