The URL can be used to link to this page

Home My WebLink AboutLA176087 � �.� �=� �� --. ��Q��,�� 'Y� � 't�is�rm mu��;c�r��n�s��,,�,�b,��6�itt��t ti�B�it�d�g�ir��specti�n for t�r�3�si�Netlor�of a manui�etu�ed�am�. AtI t�ts r��us#�e c��,�t>a�cl,�i��f-�rn thfs�Or�n. A certl�c�te�a€�r�up�nt�r w�f rr�t t� i�s,�d ur�t(I.th�+�rn�t�f�r,��s�e�. �"918�'�'�`�T��t�'�N 3 �� t�t�P�� ru�Cif 1"+�e�t �:L�:#'�5,��►C�i.��C+.BlSt(�� ; _1 - ZflZ.I b��.� �- Pr�nt i�t�e�tf�'��td C#�rt�rtyr: ' � < <� -�i Vlta��.�:��.r��r�.BlZ�y r�e: . —t5— Zcj �_"�..-� � [�rrt��#T`�r and�+�stey; . �e( e f��li1�T��Fh�1�4��`F�'3�i;�1.�iC� �� - 2OZ � Q P�rit Ns�rte of Te�te�'a��ny: � �`"`y"- � 1 � � Q�;�`+�:t'�u�tt,lo��fi��t�� . � � . � _ . .,,..� � , .. ��,;� , �rin�t�n►c�r«�er�l C��ya , ��. � {� (' �:ct��t�r�t��;�►+��►� �a�.��a o�; � v"� 1� ��r+n��r��n�: �.,,�,�.- i�e- �� - e�;c.Y,�'".. ��c�ti�t�aY�+'��G�R��.tt�1 D�; � c� �a: ( , t�m�me��'�and�rry.�,.i��. ��.�. ,G�i c�� 2�i e�i�-------�- ��+�t�t�nu�r. ��t�,+c�;�.�� n�:��' � � ` � Pri�tt idat�af't'+�ear�id ' i �"�C �� lG'T�C� c..��-�t Cz.l- ��+��7'��r�t ta�s:�€�►.�3 �asda; -1 S- 21 ��,..,,,� Prfnc N�.�T�r e��ar�,r�r - � . f cettllyyc:i�te��t�t t�wta�d�t#��q:�ar t1s�i�i1�:t�t th�prs�vtsions��ct br e� �� , , �2�r � °°` �""' tJ��'�[ �� f — i 5 — Zc� Z j �� .__. � ; '� � ' �l\` .,,.�..,: ELECTRiCAL AFFIDAVtT THIS GERTlFICATE MUST 8H�ELEC R CAL k1MTILlTY BEEORE ELECTRlCA!SERVICE C O N 7 R A C T O R A N D F I L E D W I'f H T CAN BE CONNECTE� Permit#: L.�t' ��'� Job Site Address: ��' r � Owner. � ,� � �i�� ' � �� CL� G1r�, �'"' j �-`^�� { t , .��f'��(„�� C. �..L.�-�l �*"'�7 `��4�..rC� Electrical Co�tractoNCom an Name:�� "'� P Cantractor License# CA Master El�ctrician License#: � LsE � f� Mailing Address (Contractsf; pany or Owner Perforrnirtg lns�lation): ,� Street Address � � =- � � � --+ _ �,�J,✓ �/ ' �`� . `�` T�L� Cit 4J �ti *1�.- `� State �'�`}�,.� Zip Code - , . (� Qffice Phone# �' ,��' � �� `'�," �' ;C� CanfacC Phone#: ;;f�� -��✓��7 l�� .�'' � Printed Name of Authorized Indivi 1.�� ^ � �� Authonzed Signature: "�� - __-----. . , AMPERAGE SIZE ��-'��`�r_�;�-°' SERVICE ENTRRNCE CONDUGTOR SIZE ��,f`� THREE PHASE SINGLE PHASE �_ DATE UTILITY GONNECTIC)N IS REQUESTEE? �/�`o�-`-fI '��'--f�� ----..� Lakeviile Utility Providers: Dakota Electric Xcel Energy 2l28/2006