1101 EAST FIRST STREET SANFORD FL 32771-1468 PHONE (407) 665-7050 FAX (407) 665-7486
bpcustomerservice@semiolecountyfl.gov
PROPERLY COMPLETED ELECTRICAL
SAFETY INSPECTION AFFIDAVIT MUST BE
RECEIVED FOR ALL ELECTRICAL SAFETY
INSPECTIONS PRIOR TO POWER BEING
RELEASED TO UTILITY COMPANY
PERMIT: DATE:
JOB ADDRESS:
LOT / SUBDIVISION:
COMPANY:
I, , licensed as an Electrical Contractor,
(Please print name)
license number , did personally inspect the electrical
(License number)
system of the property stated above on, . Based upon that examination
(Date & Time)
I have determined that the electrical wiring and equipment is in working condition, and
safe to be energized.
Contractor Signature Date
STATE OF FLORIDA )
COUNTY OF _______________ )
Sworn to and subscribed before me by means of [ ] physical presence or [ ] online
notarization, this _____ day of _________________, 20___, by _______________________
(name of person acknowledging), who is [ ] personally known to me; or [ ] has produced
__________________________ as identification.
_________________________________________
Signature of Notary Public (Seal)
