Fillable Electrical-permit-application-2018 - ELECTRICAL PERMIT APPLICATION 6-28-2018

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Electrical-permit-application-2018 - ELECTRICAL PERMIT APPLICATION 6-28-2018

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Inspector
Eric Woosley
EricR.Woosley@ky.gov
Phone: 270-202-4602
Fax: 270-781-9275
1141 State Street
Bowling Green, KY 42101
ELECTRICAL PERMIT
Warren County KY
Office of Building and
Electrical Services
PERMIT #_________ OFFICIAL USE ONLY DATE PAID ___________
AMOUNT DUE $
____________AMOUNT PAID $____________ CHECK #___________ CARD__________
ELECTRICAL PERMIT APPLICATION
APPLICATION DATE: ____________ PERMIT #: ____________
PROJECT INFORMATION
SITE ADDRESS:____________________________________________ PHONE NUMBER:________________________________________
BUSINESS OR OWNER NAME:________________________________________________________________________________________
MAILING ADDRESS:_____________________________________CITY: __________________STATE:__________ZIP:______________
OCCUPANT NAME:______________________________________________________________PHONE NUMBER:___________________
CONTRACTOR INFORMATION
CONTRACTORS NAME:__________________________________________________________PHONE NUMBER:__________________
MASTER ELECTRICIAN NAME:__________________________________________________CE#________________________________
POWER COMPANY:_____________________________________________________________ME#________________________________
DESCRIPTION OF WORK
SINGLE FAMILY___ TWO FAMILY___ TOWNHOUSE___ CONDOMINIUM___
MODULAR___ MULTI-FAMILY___ BASEMENT___ DETACHED ACCESSORY___
GARAGE ADDITION___ ROOM ADDITION___ FARM BLDG___ SWIM POOL___
HVAC___ SIGN___ SERVICE CHANGE___ PARTIAL REWIRE___
COMPLETE REWIRE___ TEMPORARY___ POLE SERVICE___ RR SIGNAL___
COMMERCIAL___ COMMUNICATION BOOSTER___
INSPECTIONS REQUESTED TEMP POLE_________ROUGH IN__________SERVICE ONLY___________FINAL____________
INSPECTION SITE
LOCATION/DIRECTIONS:_____________________________________________________
______________________________________________________________________________
______________________________________________________________________________
DESCRIPTION OF COMMERCIAL WORK:_____________________________________________________________________________
CONTRACT PRICE FOR COMMERCIAL WORK: $_____________________________________________________________________
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Electrical-permit-application-2018 - ELECTRICAL PERMIT APPLICATION 6-28-2018

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Completed 1 November 2019

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