Fillable UTILITY TESTING REPORT FORM (Pinal County Government)

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UTILITY TESTING REPORT FORM (Pinal County Government)

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DEPARTMENT OF FIRE, BUILDING AND LIFE SAFETY
1110 WEST WASHINGTON, SUITE 100
PHOENIX, ARIZONA 85007
OFFICE 602-364-1003 FAX 602-364-1052
UTILITY TESTING REPORT FORM
Permit Number
Installation Address
Unit Manufacturer
HUD Number
Serial Number
Installer Name
License Number
Installation Certificate Number
Dealer Name
License Number
Dealer Address
ALL TESTS SHALL COMPLY WITH 24 CFR §§ 3280 AND 3285
Note:
Water -3285.603
Sewer -3285.604
Electric -3285.701
Gas -3285.605
WATER TEST 3280.612
SEWER TEST 3280.612
GAS TEST 3280.705
ELECTRICAL TEST 3280.810 (b)
Date:
Signature:
NOTES:
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UTILITY TESTING REPORT FORM (Pinal County Government)

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Completed 25 February 2021

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