HomeMy WebLinkAbout1200 W 25 StCITY OF SANF//O..RD ELECTRICAL PERMIT APPLICATION
Permit Number: " W Date:
The undersigned hereby applies for a permit to install the following electrical:
Owner's Name: RN • ' 9t, I Mom
Address of Job: 17,06 Ull• Z9Tk
Electrical Contractor: r UjD) r70jD ly
Residential: t4 Non -Residential:
Number Amount
Addition, Alteration, Repair (Residential & Non -Residential)
New Residential:
AMP Service
New Commercial:
AMP Service
Change of Service:
From )0v _ AMP Service to ?&M_AMP Service
Manufactured Building
Other:
Description of Work:
Application Fee: $10.00
TOTAL DUE:
By Signing this application I am stating that I am in compliance with City of Sanford Electrical Code.
Applicant's Signature
EEC ODO c so Y
State License Number
nz_07 ey,a