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Owner v ' . Phone: ~.~d~ess: ' .-, ' ' <br />'ATL~zz' ReJ.d '~ ~.; . 625-55~.9 420 ~ ~o~ ~C She~ood, O~e ~7~0 <br />S~t'~s~dm~'. .;' . .~ · ~No.: Cms~'S~et. ~ . , ' ~ "1 ~ <br /> <br />Supe~isiBg Electrician' ~, ~ , r ,' Phone: ~dress , ¢ , / J" <br /> <br /> ~ , RE$1OENTIAL , '!~', . ~'- <br /> ..L~ Residence wirin~ !ess )hen 1000 sq., ........... @$ 30.00 ' ' '~, *'~"' <br /> ~ Residence wid[~g'leSS tflan 20oo <br /> ~ Residence wiring ?v'er2000 sq. ft .................................. @ $ 70.00 ' ' . <br /> i. Electrl~heetlnsta~_llatioR~o_.e,.~istJcemsidence .......... ~ ....... ,/ .... C-~$ 20~o0 I.~ ~ . <br />...... . .. <br /> esidenc~ J... ~ ....... <br /> ,,.. , '-- [ [/ ~ .%?, '~, ~, , ,,~/ · · <br /> <br />r '/ . . <br /> <br /> [ ~~ - , ION :~ " P~N REVI~ FEE <br /> ~ ' ] <br /> <br /> ~.O~OWNERS - I hem~ ~ffi~ ~at I am ~e owner ~ ~ d~,~~ich~m~ ~ ma~ an ~l~tr~l ins~flaUon for <br /> <br /> ~{QNA~flE OF APPLIC~ ~ ~[ . <br /> Rev. ~7 <br /> <br /> <br />