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JRN. 23. 2006
1: 4iPM
WITZKE ELECTRIC
NO,025
P.i
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CiIYofO'bIca'b
Diviaionoflll!ptOllonSOM..,
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O""""'\VI _3.1130
om," 02!>236-S0!Q ,
,.. 92a.23doSOI4 ' ,
EleCtric'InstallatiOn Verifi tion
155 E.
(Address)
WL
(State)
5'f90(
(Zip Code)
lid.
e pert'oxmed)
The nature of the work consists of: (Check One or Describe the ature of Work)
, I
L' Reconneotion or new circuit for replacement Hea~g Plant and/or AlC Condenser.
Reconneotion or new circuit for replacement Elec~c Water Heater or power vented
water heater,
Recocnecnon of the Service Entrance Cable, Met Box, alterations to receptacles
and lighting fixtures due to siding I soffit instal ation. Note: New Service
Entrance Cables will require a separate pexmit. !
Recocneot1on or new circuit for the replacement o~other permanently wired
appliances I fixtures.
New circuit ror the addition of AlC to an individua dwelling unit (house or the
individual systems in a duplex or condomini . including required service
electrical outlets.
- Other
at the following address:
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The value oftbis work is $ .;l.$l}.o O. ~
I here~ verify this work will be perfonned by an employee of 's company and further verify
the reconnection I instaIlation will be done in compliance with. ufaoturer and Electric code
requirements,
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(Signature of Company Officer)
/-;JS~Ò{¡;
(Date)
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