Fillable Application For Electric Permit Form printable pdf download

APPLICATION FOR ELECTRIC PERMIT

CITY OF ZION, ILLINOIS

BUILDING DEPARTMENT

(847) 746-4018

JOB LOCATION: Number and Street: ____________________________________________

LEGAL DESCRIPTION: Lot ____________ Block ____________________ Section ____________ Township

46 North, Range 12 East of the Third Principal Meridian, Lake County, Illinois

PROPERTY OWNER: ______________________________________________PHONE: ( _____ )_____________________________

ADDRESS _____________________________________CITY _______________________ STATE________ZIP___________

GENERAL CONTRACTOR: ________________________________________PHONE: ( _____ )_____________________________

ADDRESS _____________________________________CITY _______________________ STATE________ZIP___________

ELECTRICAL CONTRACTOR: ______________________________________PHONE: (______ )_____________________________

ADDRESS _____________________________________CITY _______________________ STATE________ZIP___________

LICENSE NUMBER: -___________________________ WITH CITY/VILLAGE/TOWN:____________________

CONSTRUCTION TYPE:

Residential _______Commercial ______Industrial ________ Detached Garage______ Pool/Spa_______

Number of breakers: single phase_____ three phase _______

Number:

lights _______ outlets _______ switches _______

SIZE OF SERVICE: 200 AMP ___ 100 AMP ___ Sub-Panel___ Branch Circuit___ Other: _______

Service upgrade from _______ AMP to ________AMP

OTHER REPAIRS:

Detectors: smoke # ______________

carbon monoxide #______ GFI kitchen outlets #_______

Rewire _________Additional Wiring _______Alteration _______ GFI basement outlets #_______

DETAILS:_____________________________________________________________________________

______________________________________________________________________________________

_______

TOTAL ESTIMATED VALUE OF WORK, COMPLETED: $___________________

If no work is performed hereunder within six months from the date a permit is issued or if the work is not completed within one year from the date a

permit is issued, the electrical permit shall expire by limitation as provided by City code. The undersigned applicant agrees to comply with all provisions

of the electrical ordinance of the City of Zion and with the provisions of all other law relating to the erection, repair, and alteration of buildings in effect at

the date of the permit issued hereunder. The said applicant herewith agrees not to make any changes in the plans or specifications, as approved, without

first obtaining further approval for such changes from the building inspector.

I hereby certify that I have read the Electrical section of the Zion Municipal Code and know the

contents thereof:

________________________________________________

________________

Signature of Licensed Electrician

Date

(for office use only)

PERMIT NO. EL-16-_____________

DATE PERMIT ISSUED: ______________________

PERMIT FEE: ______________