Application for Electrical Permit Form

Owner Name(Required)
If Applicable
Project Address(Required)

Contractor Information

Contractor Name
If Applicable

Scope of Work

Type of Work Being Conducted(Required)
Type of Structure(Required)
Size of Service(Required)

Applicant certifies that all information given is correct and for all work done under this permit, the permittee accepts full responsibility for compliance with the National Electric Code, and all permanent federal, state, and local electrical ordinances/laws. Permit subject to revocation or suspension of contractor license if any violations of the law are not followed. An electrical inspection will be performed upon completion of the permitted work.
MM slash DD slash YYYY

Once this permit is approved, you will receive an e-mail with instructions for payment.