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P - 77980REOUEST FOR ELECTRICAL INSPECTION '"X" Below Work Cove�ed by This Request Add Reo� Type o1 Su�ldinp ADP��snc�s Ylii�sd Home Range Duplex Water Heater Apt. Building Dryer Commercial Bldg. Furnace Industrial Bldg. A�r Conditioner F Otner veu v grm t i uec� y rte Jnspect�on Fee Below F�e Ssrviee Entranc� Si:s OtolWAms 101 to 200 Amps Above 200 AmrK CJ15 Fee Feeders�Subleeders � Oto30Am s 31 to 100 Amps Above 1�-Am s Remote Control Circ. Special Inspection S Equ�pment Wired Temporary $ervice Ugfiting Fixtures Electric Heat�ng Silo Unloader Bulk Milk Tank iher ISoec�lyl Othe� fee Circwts Oto30Am < 31 to lU0 An Above 100_ Partial!Other TOTAL FEE Rouph-�n Date �, th� Elsctr�cal � InsDSCtor, hersby c�rU}y th�t ths above F�nat �^�P insp�ction has bsen � G� meds. This request void 12 months from � —rs�s�s � :r=rrr+rsa-:c:��a��::::a::�sa��-��s — �y� This request void /t./ � �� 12 months from ,. ��,� � C�(:` \ `�' �-�'`1 'J (c- �` : � :�(� Ra4uest Date Fi�e No. Roupn-�n inspect�on �'j tiequired� f�Ready Now Q W�II NoUfy Inspec• �L. �% ❑�es No ry �or When ReadY � L�censed Electncal Contracwr 1 A�r�by r�quest inspection of abovs �Owner al�ctricsl work Installsd at: Street Address, Box or Route No. �,�� au a� �q C f-, � �t Occupsnt IPRINT) Pnone No. o i� �.� v 3488 . �63-- -��G� Povwr SuDDlia � . Address C�e Electncal oryfl'�o� ICompany Namel Contractor's License No. il�np Addr�ss TConlrsctor ot Ownsr Makinp Ins Ilat�on) /�S/� f,� � L� �� „ r�•� � C�� (Com�actor/Ownef Mak�n Installation) / Pho�e Number �� ►� s,� -sn �-a o