P - 81361F+1I�IIII II I I III (I IIII II II) M8 n�UEaS�taOBELR� SR'CaLS?NS PEMNION04 ���
�� * 0 3 9 2 0 8 7 3* Pno�e �s � z) sa2-osoo ;�:�, �; ,--�•�°r;
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air
�atl Mgmt. O}her:
mp. Service
in this space and on fhe back ot the white copy only.
_�AVr`:ii'=� `_�WI;::H SAISTALLATIDN
Calculate Inspection Fee - This Inspection Fepuesf wi0 not be accepted without the cwrect 1ee:
Other Fee +� Service Enhance Size Fee � Cirouits/Feeders Fee
Mobile Ffome Park Stall 0 to 200 Amps 0 to 100 Amps
Street Lta/Traffic Sia. Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY I TOTAL
Sign/Outline Ltg. Xfmr. � X,�, .;j:�+
Alarm/Remote Conhol
Swimming Pool I hereby certiy ihat I lnspec[etl ihe elechicel lns�ellaflon tlesanbed herein on Ihe tla�es s�atetl
Irrigation Boom aougn-i� oate
-,� Special Inspection F_ ai � - te qq
Investigative Fee ��' � ^2 � / J
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WI IN 18 MONTHS.
OFFICE USE ONLY This request void 18 monihs bom validation tlate printetl in this box.
392-087� . �`S �
/�G
zo� xu,:�L.: u•:,;>,�€�c�,��
PLEASE PRINT OR TYPE -
Reques[ Date Rough-in Inspection requiretl? 0 Yes q No Inspection Other Than Fough-Irt 4 Reatly Now � Will Gall
.� :. t {�i"f i `:1 Ci
�Ym must call the inspec�or when ready) 1 pate Reatly: '
��—I—z�
I, �] licensed contractor ❑ owner herehy request inspection of [he above electrical work at:
Job Atltlress (SVee�, Boz, or Routv= NoJ Giry Dp Cotle
Civ'iRFiOi n"(".T•' CRFRK TFR NF Fr,�in?FV r..:..n�:<-�.
Section No. I TownsM1iv �� or No.
rowe. s�vPi�e.
CWniy
No.
EB-00001A-11 8/95 STATE BOARD COPV - SEE INSTROCTIONS ON BACK OF YELLOW COPV t�� `� �- -' —�'