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CITY OF SANFO,/RD ELECTRICAL PERMIT APPLICATION
PermitNumber: o-Z :I Z - Date: t -/& -c`z The
undersigned hereby applies for a permit to install the following electrical: Owner'
s Name: U t. S C« rt ku % C n U{r =ail Address
of Job: .GEC% SC • hl K Ic' Electrical
Contractor. ;u h 'l /PC_ Residential:
Non -Residential: X Number
Amount Addition,
Alteration, Repair Residential & Non -Residential CO, New
Residential: AMP
Service New
Commercial: AMP
Service Change
of Service: From
AMP Service to AMP Service Manufactured
Building Other.
Description
of Work: 4rld :4C. V?,Sranr-70e r ro (f N, Application Fee:
10.00 TOTAL DUE:
By Signing
this application I am stating that I am in compliance with City of Sanford Electrical Code. Applica s
Si nature State License
Number