Simpson County Electrical Permit Application

ELECTRICAL PERMIT APPLICATION
PERMIT APPLICATION SHALL BE COMPLETED AND HAVE UTILITY SIGNATURE AND ALL FEES PAID BEFORE PERMIT SHALL BE ISSUED ALL FEES DOUBLE IF WORK IS STARTED BEFORE A PERMIT IS ISSUED
MonthDayYear
Date
ResidentalCommercial (Submit Contract Below)Industrial (Submit Contract Below)Other
Type of Inspection
Temp. ServiceRough inService OnlyChange of ServiceFinalOther
Location of Work Address*
Owners Name*
Address

Address

Street Address Line 2

CityState

Zip
Phone*
Format: (000) 000-0000.
Electricial Contractor*
Phone*
Format: (000) 000-0000.
Address*

Address

Street Address Line 2

CityState

Zip
ME*
CE*
EPBWRECC
Underground
Overhead
Service Size
Phase(s)
Voltages
Motor Load Total H.P.
Special Loads
Other
Other
Date

MonthDayYear
Date
File Upload

Cancelof
Electrician Signature*
Email*
example@example.com
Should be Empty:

ELECTRICAL PERMIT APPLICATION