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• CITY OF L•'tIERETI` <br /> ' . • - • ' <br /> � APPLICATION <br /> ELECTRICAL 4JIRING PEI2A9IT <br /> . JOB AUDRESS �7/� '/�, IU�f�) l'YT � ���R�crQen {-eC�0.� S.2W�Ce <br /> US� OF BOILDII4G Q�,[ I�'. P C <br /> PROPERTY Oi9NER _ F I^2_��7 � O � I� { � � S <br /> CON9'RACTOR � (,� � • LICENSE N0. C �� J a... <br /> VALUE OF S+IORIC (comm. ) C� ^`� TELrPHONE NO. �SS-/�- �� <br /> WORY. TO B� DONIi: <br /> _ NEW ALTI:RJtmION REPAIR REI�liACE <br /> NIRING _ NUAfIIER OF CIRCUITS 12�V Y 2qOV <br /> /' —�-- <br /> {�.1J�`��SERVICE _ NUM$ER OF CIRCUITS _ 120V 290V <br /> � � <br /> SIZE AMPS <br /> _ FORCfiD AIR FURNnCE K.iO. (MECHANICAL PE?2A1IT <br /> ALSO REQUIR�D <br /> � - � _ BASBIIOARD TOTAL WATTS <br /> i DESCRIBE WORK TO BE DONE �C�,. v 1 < L.. <br /> �"J rr, �00�-r� ��.� f�- '� Q C7 (j � ,� �( l��I <br /> _�_ /, � <br /> -----� ', <br /> SIGNED IIY ��D�,g � � l � <br /> �' 1 <br /> DO NOT T4P.I"_'i: 33P;LOS� TI1IS LINB <br /> NOTES & COA91�1GNTS <br /> i <br /> � <br /> TOTI�L FEE • �v I <br /> APP}20VIiD 13Y <br /> DITE <br /> 1'LL SC1113DOLE ON '.ZLVERSP: SIllIi <br />