| Property Address | |||
| City | State | ||
| Zip | |||
| Owner Name | |
| Owner Phone | |
| Owner Email | |
| Tenant / Site Contact |
| Contractor Company Name | |||
| Contractor License Number | |||
| Contractor Contact Name | |||
| Contractor Phone | |||
| Contractor Address | |||
| Work Type | ☐ Service Upgrade ☐ New Construction ☐ Remodel ☐ EV Charger ☐ Panel Upgrade ☐ Other |
| Scope Summary | |
| Existing Panel / Service Amperage | |
| New / Upgraded Panel / Service Amperage | |
| Number of New Circuits | |
| Circuit / Equipment Notes |
| Total Connected Load (if required) | |
| Load Calculation Required | ☐ Yes ☐ No |
| Plans / Drawings Attached | ☐ Yes ☐ No |
| AHJ Name | |
| AHJ Website / URL | |
| AHJ Permit Office Contact | |
| Permit Application Date | |
| Permit Number (once issued) | |
| Permit Fee Paid |
| Estimated Inspection Date | |
| Inspection Result | |
| Inspector Name / Badge | |
| Follow-Up Items |