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P - 78648""X"" Se/ow Work Covered by This Request Add Rep. Type ot Buildinq Apo�iancss Wirsd Home Range Duplex Water Heater Apt. Bwlding Dryer Commerciai Bldg. Furnace Industrial Bldg. Air Conditioner F tner oeci v arm t r yec�fy ite lnspectron fee Below Fsa S�rvic�Entrane�Sizs 0 t0 l 0U ,4m S 101 to 200 Am �gns Fi�al Th�s reQuest w�d 18 nqnths f�om Fee Feeders/Subfeeders ! Oto30Am s 31 to 100 qmps Above 100_Am s Remote Control Circ. Special�nspection 5 lP. ��6J Equ�pment Wired Temporary $ervice Lighting Fixtures Electric Heat�nq Silo Unloader Bulk Milk Tank the� ISpec�fyl Olhgr ies Circuits 0 to 30 Am 31 to 100 Am , Above 100_� Partial!Other F `� TOTAL FEE �. ibe E�ectriu� Inapector, f�sreby certily thet the �bovs inspsction has basn mede. ,rs�= �r-r ��s��..�r...a...� ��.. �rc �r � � ��w �� -. ��+� /v.Ov Th�s request w�d ,8 ,��t��.f.�, �vd� - bo�� ,� �� 2 2 6 � Request ce Rre.No. pouph-�n Inspecuon ��% fj Requ�red? �Readv Now [j W�il Nol�fv InsDec- / 'v y ❑�es �No tor When Ready L�censed Electr�cal Co�tr o I ti�r�by .�queat inspect�o� of above ❑ Owner '� �� 8�� elsctrical work ins�all�d at: � Street Address, Box /r Route No. , C�t Occupa IPRINT) �l Ai � � L Power SupD� er Addre Eieca 1 Contrac 1 ompany Namel Mailinp Address ICo ractor q Owner inp Inst ' �oi �lD 1 �u��a �s �F,�,�2{ Author�zed Sio�ature (Co ractor Owner Mak��p Installat Pnone No. l y ��. Contractor's License No.