Division of Professions and Occupations
Notice of Intent to Commence/Cease Permitting and Inspection Services

The Town, City, County, or City/County of:

Is hereby serving written notice to the:
Electrical Board
Plumbing Board
(Separate notice is required for each Board)

For the intent to:
Cease providing permitting and inspection services
Commence providing permitting and inspection services

Beginning July 1, 20

JURISDICTIONAL INFORMATION
Jurisdictional Name:
Building Official:
Phone:
E-mail:
Fax:
Mailing Address:
Inspector Supervisor:
Phone:
E-mail:
Fax:

INSPECTOR INFORMATION
Electrical
Plumbing
Name:
Phone:
E-mail:
Fax:
Residential Certified #
Commercial Certified #
Dual Certified #
Master License #
Journeyman License #
Residential license #

Electrical
Plumbing
Name:
Phone:
E-mail:
Fax:
Residential Certified #
Commercial Certified #
Dual Certified #
Master License #
Journeyman License #
Residential license #


Electrical
Plumbing
Name:
Phone:
E-mail:
Fax:
Residential Certified #
Commercial Certified #
Dual Certified #
Master License #
Journeyman License #
Residential license #


Electrical
Plumbing
Name:
Phone:
E-mail:
Fax:
Residential Certified #
Commercial Certified #
Dual Certified #
Master License #
Journeyman License #
Residential license #


Electrical
Plumbing
Name:
Phone:
E-mail:
Fax:
Residential Certified #
Commercial Certified #
Dual Certified #
Master License #
Journeyman License #
Residential license #



Consumer Protection