Request for Lighting Service Form

Additional Information

Provide a copy of the following documents

  • Legal description of property or copy of last recorded deed
  • County assessor’s parcel map indicating home site(s), easements, and rights-of-way
  • Detailed plot plan

Customer Certification

I certify that the information provided on this form is accurate and complete to the best of my knowledge; and that I own, lease, or have a contract to purchase the property or premises referenced in this request for service or I have been authorized by the owner or lessee to complete this request on their behalf.

  • Applicant Information (Please print full, legal name, or business name)

    Owner Information:

  • Contact Information

  • Project Information

  • Light Type

  • Specific Requirements

  • Verification

  • Example: 12