HomeMy WebLinkAboutElectrical Permit 12. 242 i
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Transient Operation Permit
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I am the owner /agent of the described equipment and hereby request inspection of the - - -- • - r rumi.`
Date(s) of Inspection Requested Time of Inspection Permit # / ��� (p 3E
7 - a - ? iy .�t//✓✓�� l:e
Address of Inspection - Street or Location Cit
27'7 t -eldr P4eZ 500o p /��'/17, L4 2 County_
Event A ,q
2 -. 5. f
',lent nName t/Ow c 6/ 6 Un f& c -ems - r * c
Owner Mailing Addr ss - Str
?" d n / City ` �� State ZIP
Owner/Agent ' Telephone Number(s) - Include / Area � Code(s) Owner /Age tt EE- mma A esss `/ ve/ C''/
Owner /Agen ignature w Title e l . 1___
di , ' Fee Calculation
Name or Type of Equipment Equipment Identification Number Amps Fee
6 .-,4 7o,Q5 (II • 13 --- .--� 20 4 , J/d
) to _ & ,,,,, c I . d t ,t , t et , 5: le
( ) Re- Inspections @ $35 each
(/, O ) hours @ $80 per hour AO
Total SO '
$ zza °
Operators are subject to an additional $100 fee if the Department is no n o i i a least 4 s advance of each setup. oe`x� v �
The operator /agent must notify the Department at least 48 hours in advance of any engagement that is canceled or the fee is forfeited.
A service charge of $30 will be added for all dishonored checks.
inspection Date(s) Inspector Siignatur ) ■ Inspector Number(s)