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Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm ���� Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
D er Ran e Elec. Heat Tem . Service
"JC' above the work covered by this request. Enter remarks in fhis space and on the back of the white copy only.
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Calculate Inspe�fion Fee - 7his Inspection Request will noi be accepted without the correct fee:
OlFier Fee # Servi ntra e Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 t 2 0 mps � 0 to 100 Amps ;c.�
$treet Ltg./Traffic $ig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR's usE oNLY TOTAL
$ign/Outline Ltg. Xfmr.
Alarm/Remote Control 2j ��j 1 3 � _7
Swimming Pool ��✓t -�� --' � � Z�' �JY
I hereb ceAi fhat I ins eded the el I insMl�afion des herein on fhe dotes sTafed
Irrigation Boom Rough-In Dote
$pecial Inspedion t� �
Investigative Fee Final par� � /��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 ONTHS.
2 9 9- 3 8 6�] OfFICE USE ONLY This requesf void 18 months from validafion dafe prinfed in this box.
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PLEASE PRINT OR TYPE � �� �-� � � � ✓�
Request Dak (� Rough-in inspecfion required2 � Yes � No Insp$ction Other Than Rough-In: � Ready Now � Will Call
.� � s�7 � (You must mll the inspedor when reody) Date Ready:
I, ❑ licensed coniractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or RouM No.) City Zip Code
��+Z �' r�/ 2!,'h� /t.t �!e-[ �DC.Cy ��.3 �
Settion No. Township Name or No. Ronae No F�ro N.. r',.,�.,�,.
Vi't ��c—tf�
Power upplier �
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Eledri I ConhatTOr (Comyny Nam���
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Mailing Add ss (Conirocfor or Owner Perfortning
Authorized ' nature�(Confratlor or Perfom
EB-00001 1 6/95 STATE BOA
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Address
Contrador License No.
SEE INSTRUCTIONS ON BACK OF
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Master Lic. No. (Plant Eled. Only)
Phone No.