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FR lOM' : PlbEM ELECTRIC INC � PHONE NO, <br /> • � Nov. 27 201 01:29Ph1 P2 <br /> SERM8 REQUEST <br /> Typc of BusincsS or'f ropertyFACI���JD 9 —�„U–E–S <br /> SEIiVlCf�ftleQT;:,��—��1�"' <br /> ovrHFRI ar�:,wroft <br /> J � grrl.�r,c PAyz-rr p <br /> srrE anaRess <br /> Mailing Address (il 0ifferetlt tram site Address) <br /> crrY <br /> �TATt zw <br /> prs i ttC 41 AP t1# Lotto Usi c Ap P ucAwti*;! <br /> f}HQNf,Ill ixr. BQ5 D mrtucT - <br /> f.-0UlTK3N Cgnt:` <br /> w CONTRACTOR l 587 ME RERIIESTOR <br /> REqur-yroR <br /> l CI fC / Sktr4 PARry <br /> BUSINt 5tiAUE PtroH�fl <br /> Al <br /> ht.nruHG AgrapRi�ss <br /> FAX 0 <br /> Vry <br /> P�LstM <br /> 11JG ACKNONILf dGEh1cNT: !, No undcss;gncct property to Business atimar,apcs�tnr a aulhatizud agani aF xxrne asluwwf,aciga tftat 3�a3e axldlor <br /> >c Ht—ALM SF�vtc�s Erv^r�ccru,rGtrr.,�NEUTN i7ms>rw i�aurty r�arges associ3t�d�h tt� ar P+�i�t�peciC,c <br /> Jaaj� a wilt bts 6t�icd Oo m�or my b�irless�idcrttir�ecl wx�tvrrrti <br /> I alao wlOj low 4 Mane prapatcd�1i�appGcyticu�and trot rho work Da uC pctlpnncd tM tkx►c in acmntanca with aA SAN <br /> f•EDERAL 4�w:. Ja 4ffl CWM Ort L,&=Calot,51ardy,ds,STALE and <br /> 4 hPPLh=^MT SiGf�1TU RE_ . <br /> (1 MSE f/ /�d • �,G�/ <br /> PRwER rr I aus+r,a ss owt,,c"u ❑., OPERATCR I&%V0.(EA A (hurt AtnttatuxEo AGEMf <br /> q'MFt.�-wP:a ncd'G'��p�pr�(al�v>rtcrlrt!{c�r�h sips b fr9�+�d Title <br /> �1U1 FiQR TON TOR LEAS FORM ATI :wbm appvjbtci)_Lha uwntr oraperator of tlm property bMbDd a(U-4 agora site xddruss,he <br /> any and all,sults pevtechni�l data amV<x txrvirgruoertlaY ina awoazrr�nl>ntwz�dOra m om Smrrt COUNTY Puax HE&Ttt S�Rvac�s E rnrtaz '�� 1lutltprira the of <br /> r4iar�so <br /> as r1 fs a'ia&Iblo and at U1 lame ttme it is pSC7v"to m or ry mp-c1erti=Vo. CrUrF![IA! HFA-.H DM W41 as loon <br /> ryPE aF S Exv)cE RE4uesr�: <br /> concuEnT;: <br /> IVOV ,) <br /> fl <br /> SAN C J() t , <br /> VIRON rNr A f AL[. <br /> ttj�t1Uls,,v,, <br /> 111;P CCTC R'S S tGHATURE OOIirFAGTOfirS$IGMhTIJRr <br /> Al PFIOYFLI[31: �!/�ij !~itYL� ' �1S <br /> RR DATE: <br /> r1SSlG HE]TQ: EWPd[]Y E <br /> •J j DATE: <br /> Date Scrvlcc COrfl! d (rf air compteted}: <br /> Fee Amount: 700 Amount paid (. J <br /> �'�..� ,.�..-"��,7 �— AaYrrtuttQatc <br /> Payment Type lnvoicc lk C?1etfC tk <br /> r17 Rccclved BY: � �") <br />