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BROWN COUNTY BUILDING DEPT. ELECTRIC SERVICE UPGRADE. PERMIT APPLICATION PHONE [PHONE REDACTED] FAX [PHONE REDACTED] OFFICE USE ONLY PERMIT # FEE: $35 ( ) cash ( ) check # PARCEL DATE: RECEIVED BY: Location of proposed construction activity: Address: City: Zip: Owner of above location: Name: Address: City: Zip: Telephone: ( Contractor responsible for this Permit: Company Name: Contact Person: Company Address: City and Zip: Brown County Electric License Phone I, hereby, certify that I have the authority to make the foregoing application, and that all accompanying documents are accurate and complete; I further certify that all electrical work will be done and inspected in accordance with the current Indiana Electric Code and all other applicable Building Codes and Ordinances. I agree to have a Brown County Licensed Electrician on site, and supervising, while any electric work is being done. FAILURE TO COMPLY CAN RESULT IN THE SUSPENSION OF YOUR BROWN COUNTY LICENSE. Signature of Owner: Signature of Date: Principle Use of Structure (check one): o Residential o Multi – Family of units: o Commercial o Industrial o Agriculture Nature of Electrical Work to be done: (check all that apply) o Mobile Home/Replace Service o Modular Home/Replace Service o Replacement/Upgrade Service Entry Meter Base Panel o Repair, alteration or remodeling o Other, specify: Voltage: Phase: Number of Meters: Service Conductors: # of Sets: # of Main disconnects: amps