ELECTRICAL PERMIT APPLICATION

Property Owner's Name*

First Name Last Name

Property Address*

Home Phone*

- Area Code Phone Number

Fax (Optional)

- Area Code Phone Number

E-mail (Optional)

Address*

Sub Division Or Lot

Use Of Structure*

Residential Commercial / Industrial Multi-Family Vacant Lot

Other Use of Structure

Full Name*

First Name Last Name

Company's Name*

Address*

Work Phone*

- Area Code Phone Number

Fax

- Area Code Phone Number

E-mail

Nature of Work To Be Performed*

Installation Meter Base / Riser Replacement Repair, Replacement, or Remodeling Mobile Home Temporary

Other

Phase Required*

Single Phase Three Phase

Total Amps*

Number Of Panel Boxes*

Is The Structrial Building Permit Already Issued?*

Yes No

Total Cost Of Job*