DE (302) 292-2000, MD (410) 289-5500 - FAX (302) 292-0900 Address Development DATE STATUS COMMENTS INSPECTOR Owner Phone # Occupied as Occupant Permit # Work Area (Floor# etc.) New Old □ □ Fee Remitted - $ Cash [ ] Check [ ] [ ] Water Heater Temp Service Rough Wiring Outlets Amp Service KW Daycare Fixtures Range Air Conditioner KW Receptacles Dishwasher Vent Fans KW Solar KW Switches Pump Survey Garbage Disposal HP Amp Service Conductor Dryer Heater Other KW Overhead/Lateral Applicant's Signature Company Address Exp. Date Phone # Name of Utility Electrician Permit OK Lic. □ □ 1111 Polly Drummond Office Park, Newark, DE 19711 OK 30305 Vines Creek Rd Suite 1, Dagsboro, DE 19939 Daycare Fixtures Air Conditioner Range KW Vent Fans KW Solar Receptacles Dishwasher KW Switches Garbage Disposal Pump Survey HP Amp Service Conductor Dryer Heater Other KW Overhead/Lateral Mail [ ] [ ] Date Fee Paid / Charge Temp # CFT [ ] Contractor [ ] [ ] L/A [ ] Owner [ ] Final # [ ] Invoice # Cash R/W [ ] Utility [ ] Check # Other Other [ ] [ ] M/0 # CODES Red Notice Label [ ] CFT Certificate LA - Letter of Approval PGS Progress SUR - – – Other Side [ ]
Rough Wiring Outlets Amp Service Water Heater KW Temp Service Fixtures Range KW Air Conditioner Daycare Receptacles Dishwasher KW Vent Fans KW Solar Switches Garbage Disposal HP Pump Survey Amp Service Conductor Overhead/Lateral Dryer KW Heater Other Fixtures Range KW Air Conditioner Daycare Receptacles Dishwasher KW Vent Fans KW Solar Switches Garbage Disposal HP Pump Survey Amp Service Conductor Overhead/Lateral Dryer KW Heater Other Date Fee Paid / Charge Invoice # Cash Check # M/0 # Address Development Owner Phone # Occupied as Occupant Permit # Work Area (Floor# etc.) □ New □ Old Fee Remitted - $ [ ] Cash [ ] Check [ ] Applicant's Signature Company Address Phone # Exp. Date Name of Utility Electrician □ Lic. OK □ Permit OK [ ] Mail [ ] [ ] CFT [ ] L/A [ ] R/W [ ] Other [ ] Contractor [ ] Owner [ ] Utility [ ] Other [ ] Temp # [ ] Final # [ ] Red Notice Label [ ] Other Side DE (302) 292-2000, MD (410) 289-5500 - FAX (302) 292-0900 DATE STATUS COMMENTS INSPECTOR 1111 Polly Drummond Office Park, Newark, DE 19711 30305 Vines Creek Rd Suite 1, Dagsboro, DE 19939 CODES CFT – Certificate LA - Letter of Approval PGS – Progress SUR -