New Construction

Name of person submitting this form

Phone number of person submitting this form

Email address of person submitting this form

Project Name

Owner's Name

Owner's Phone Number

Additional Name

Phone Number

Owner's Email

Owner's mailing address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

911 Address of New Service

Address

City/Town

State/Province

ZIP/Postal Code

Legal Description

Range-Township-Section-¼ section

Subdivision name-Lot-Block

Other…

Range-Township-Section-¼ Section

Subdivision Name-Lot-Block

Electrical Contractor

Electrical Contractor Contact Name

Electrical Contact Phone Number

Wiring Permit

please upload image of wiring permit

One file only.
20 MB limit.
Allowed types: gif, jpg, jpeg, png.

General Contractor

General Contractor Contact Name

Contractor Contact Phone Number

Name of Excavator

Excavator Contact Name

Excavator Contact Phone Number

Date estimate is needed?

Date service is needed

Any other comments?