Application for Electrical Permit

Code Enforcement Department

Job Information

To the Board of Commissioners of Springfield Township:
I (We) hereby apply for a permit to construct the following work (give exact location)
Item
Number
Ceiling Outlets
Switches
Plug Receptacles
Total Outlets
Air Heaters
Ranges
Signs
Water Heater
Lighting Circuits
Other Circuits
Total Circuits
Motors
Use the Drawing Tool to Sign the Form in the Box Below

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