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Electrical Permit Application

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Steps

1. Complete and submit application online or print the pdf version. This section is complete This section is incomplete
2. Description of Service This section is complete This section is incomplete
3. Electrician Information This section is complete This section is incomplete
4. Applicant Signature This section is complete This section is incomplete

Complete and submit application online or print the pdf version.

Electrical Permit Application (printable)
Electrical Permit Application (PDF)
Property Information
Property Location*
Owner's Name*
Email Address
Address (if different from property location)
City
State
Zip Code
Phone Number
Fax Number
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Description of Service

Type of Service
1. Temporary Service
2. Residential
3. Generator
4. Change size of Service Entrance _____ to _____ Panel Size ______
Description of Work
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Electrician Information

Electrician Name*
Email Address
Mailing Address*
City*
State*
Zip Code*
Phone Number*
Fax Number
License Number*
Versant Power Service Order Number
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Applicant Signature

I hereby certify that the information submitted above is correct and I agree to conform to all applicable laws of this jurisdiction. In addition, I certify that the Electrical Inspector shall have the authority to enter all areas covered by this permit at any reasonable hour to enforce the provisions of the codes applicable to this permit.
Applicant Signature*
Date*

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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