HomeMy WebLinkAbout05040184-ApplicationAPPLICATION FOR ELECTRI
CONTRACTOR
INFORMATION:
APPLICANT
INFORMATION:
TYPE of WORK:
NAME
Property Owner
(or agent}
PHONE FAX
RESIDENT[AL:
CONTACT PHONE:
ConLractor
OR Representative
COMMERCIAL: __
PROPERLY OWNER NAME(S):
PROPERTY (~. ~' ~ c ~-
OWNER
~NFORMA~ON:
I [NFORMA~ON. ~
OF I PROVE E T
PHONE:
CRy State 7Jp
Oty State Zip
TIME OF INSPECTION:
MOl/lNG SERVICE FROM OVERHEAD
TO UNDERGROUND?
CD UPGRADE SERVICE: From to
[] UPGRADE PANEL BOARD(S) [AFC~ BREAKERS REQUIRED]
~g~ ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
[] NEVV METER SERVICE (i,e. Fountain in pond;
Subdivision street or signage lighting; [nstallation of
new utility services for an area)
123 ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
CD CONNECTION or RECONNEClrlON TO A RELOCATED
STRUCTURE
COMMENTS or
[] YES ~ NO
Number of NEW CIRCUITS: o
Number of METERS:. ~
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
S:permlts/Foffn~Electr!cal Appllcat~n Oct 2003