EVSE Permit Application
Applicant Information
Applicant Name
Business Name (if applicable)
Phone Number
Email Address
Mailing Address
Project Location
Project Street Address
City
ZIP Code
EVSE Details
EVSE Type
Level 1
Level 2
DC Fast Charger
Connector Type
Number of Ports
Power Rating (kW)
Manufacturer
Model
Electrical Contractor Information
Contractor Name
License Number
Contractor Phone
Contractor Email
Site Plan Upload
Site Plan (PDF, JPG, or PNG)
Additional Information
Comments or Special Requirements