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Electric Installation Verification
t:L,:C-Tre t c
(Electrical Contractor Name)
L/Cio & «0 ¡:¡:: Pi Ct(!:Ti W.I,
(Address) (City) (State) f7:-:- ("'riel
have been contracted to pcrfoml electric installation work f1PjJ:1iJ!J tJ..5J: tf;1J.. .p) II H1 £1 ~r
(Name of party coûüaCted to)
atthefollowingaddress: _r 37 WO,;)()¿ ,vII!'.'!!L .
(Address where work will be perfonned)
¡(We)
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The nature of the work consists of: (Check One or Describe the Nature of Work)
- Reconnection or new circuit for replacement Heating Plant and/or AlC Condenser.
Reconne(.tion or new circuit for repla.eemcnt Electric Water Heater or power vented
watl~ heater.
Reconnection of the Service Entrance Cable, Meter Box, alterations to receptacles
and lighting fixtures due to siding I soffit installation. Note; New Service
Entrance Cables will require a separate pennit.
-I- Reeonnection Or new circuit for the replacement ()f other permanently wired
appliances I fixtures.
-- New circuit for ¡hi; addition of A/C to an individual dwelling Ulli¡' (house or the
indlviúuaI syst<:ms in a ciupiex or condominium), inCÎuäing required service
electrical outlets.
- Other
The value of this work is $ ZOO. t:J..!-
I hereby verify this work will be perfonned bv an empJnJiP-" "fthi. company and nlithe, vc:rity
the ,<:connectiOn f Installation will be done in compliance with manufacturer and Electric code
requirements.
~'Ll/f' D I. Væ,t;'î(LI:?1('
(Print Name of Officer)
3-1-1:>6
(Date)
5102
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