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- � <br /> C`ITY OF DE C�TL�2, ILL•i�i OIS <br /> LICENSE APPLICATION <br /> ELECTRIC.aI. COti�CTOR/ ELECTRICL�`S <br /> CO_N'�CTOR /� <br /> �iame R,c�aen �-% . EN t�C AI,.E' <br /> DB/�, �c. �O ,�!Gd t� <br /> Business :�,ddrecc Z.22.1 �,�11J�R <br /> i_iiv�� StaZe =,Z Zip �.,1..52�-30�� <br /> Telephone �l'�_ q 12a�_ F.�,X NdN� <br /> Insurance Carrier_�t-�T� F�4Q,�� �,{p pl�g t1q�„T{ +�, <br /> (_4tta py of Po(icy meeting ordinance requirements) <br /> Elec rical ontra A ican ' nature � <br /> Licensed Electrician in manage e supervisory gosition <br /> �iame �M� <br /> Address <br /> City State Zip <br /> Telephone <br /> Location of Iicense (city) Ezpiration date <br /> Electricians signature �- <br /> (inctude copy of licensej Cost S �0.00 <br /> ELEC'TRICIA�ti- City of Decatur <br /> Ivame ��c.�t ARt� C . �N6Dr4t� <br /> Address �N � <br /> City fl�,�.hlr2. State 2� Zip -3d <br /> Telephone - �3 <br /> Signature Date �-'l-9(� <br /> Who mav sign for your permits? <br /> �Vam�� �dtt�k l4. �.J6DAcL.� '_natur � <br /> i�ame Signature <br /> Name Si�nature <br /> Cost�, 50.00 or both ticense mav be obtained for singie fee <br /> Nla.ke checks pa�able to: CITY OF DECaTIJR <br />