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Inspection Request Form (Revised 03/04)

Attention:  Traffic Signals Division 

New Traffic Signal or Design Modifcation Inspection Requested
Instructions:  Complete form, print and FAX to (480) 312-5539 three working days prior to Inspection Request Date.

The following inspection, conference or assistance is requested:
Intersection:
Inspection Point:
(Check One)		 Pre-construction Conference
Concrete pour
Backfill of conduit
Pullbox installs
Wire Pulls
Cabinet Wiring
Final Inspection
Turn On
Re-Inspection
Inspection Request Date:
Contractor:
Contractor Fax/Phone: