Electric Vehicle Charging Station Maintenance Permit Application
Applicant Information
Full Name
Organization/Company
Email Address
Phone Number
Mailing Address
Charging Station Location
Station Name/ID
Station Address
Type of Charging Station
Level 1
Level 2
DC Fast Charger
Maintenance Details
Type of Maintenance
Routine Inspection
Repair
Upgrade
Other
Description of Maintenance Work
Planned Maintenance Date
Start Time
End Time
Maintenance Personnel Names
Applicant Signature
Signature
Date