Electrical Permit Application

< Electrical Permit Application

Applicant Name:

Applicant Address:

Applicant City, State, Zip:

Applicant Phone Number:

Applicant Email:

Please attach all Contractors for the project. If a contractor is not found above, fill out their information below.

Contractor Name:

Contractor Phone:

Contractor License Number:

Electrical Contractor:

Description:

Project Cost:

District:

Electrical Service Provider:

Size & Type of Service Amp, Volt, Phase:

Additional Information:

E-Signature:

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