P - 81380,�IIIIIIIIIII IfIIII�I�III�III�I�Illllll� II III� MS �n Uo a SsaO Bv aLRo SRe1C8c5tNP PEMNION04 ����,
* 0 3 9 2 3 9 3 5* P�o�efs�2�saz-oaoo ��•-`
Home Duplex Apt. Bldg. Other: New Addn
\ir Cond. Htg Equip. Water Htr. ;{ Load Mgmt. Other:
)ryer Range Elec. Heat emp. Service
above the work covered by this request Enfer remarks in this space antl on the back oi the white copy
SAVER'S SWITCH INSTALLATION
Calculate /nspecfbn Fee - This In$oecfion Fequest will not be acceptetl withou[ [he caiec[ fee:
Other Fee � Service Entrance Size Fee � Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sheet Ltg./Traffic Sig. Above 200_Amps A6ove 100_Amps
Transformer/Generator INSPECTOR'S 11SE ONLY TOTAL
Si9n/Outline Ltg. Xfmr. , SQ{
Alarm/Remote Control
Speciallnspection - Finai
Dale 4
Imestigative Fee G —�G �/
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLEiED WITHIN 18 MONTHS.
OFFICE USE ONLV This request witl 18 moMhs irom valitlation date prin�ed In ihls box.
392-39�5] �, �g- �
/a6
JdB NUMBER #5$0E,0m0
PLEASE PRINT OR TYPE
a����l 1l'3iZ1 / 98 ao�en-m ��spe�eo� ,�a��rea? p ves p� mso��oaan� rn� a��gn-m: � a�amt Now p w,u �u
(Veu must call the inspectar wM1en reatly) Date Reatly:
I, �J licensed contractor ❑ owr�er here6y request inspection of the above electrical work at:
Job Address (Sireet Bor, or qou[e Na) City Zip Gotle
Sectbn No. T nship Name rn No. Range No. Flre No. Countv
Occupant
Name)
Phone No.
Phone No.
EB-00001A-11 6/g5 STATE BOARD COPY - SEE INSTflUCTIONS ON BACKifSF 1'�LLOIN �IV �� 1:' ! Ys7�Q —