HomeMy WebLinkAboutelectrical application_10.pdf ,
. Department of Community�75 South Front.**Rwd mentt
TOWNurVAit' TN 9 111557
9
www.va-pov cam
ELECTRICAL PERMIT
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_Floor plan/Site plan showing proposed work _Occupancy Group listed on plans
_Load Calculations and one-line diagram when loads or circuits are being added _Building Type
NOTE:For Multi—Family and Commercial buildings-plans and calculations must be prepared by a Colorado Licensed Electrical Engineer
Project
.13'144 B
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(Number) (Street) be 0) Building Permit#:
euvitditplCornplex Name: Jh 1406166)Ebatrical Permit#:
Project1 �''� l !
Owner ill._ ._ J/- __Itc h&S Lot#: Blo k# Subdivision:
Parcel# a,,.,II -£2 ?._.. e - (2:26?
Ther esatestroUr ceuw naeswora onto.at(ssap»ame or visit ' Define Scope and Location of
Contractor
sC-4:31°P oC ai ate?"-tp 4
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BuBusiness Name -�,• �,nJtl��C�.
Business Address: " C opt rW!1
City iniiiM State: !'e, Zip: 8/6 SLS'
Contact Name: -73"• I 16 t t.">n
Contact Phone: - o ..: . I, 3
Contact E-Mail: 6;11 n/t@ NCS,. .ne. (use additional shed if necessary)
I hereby acknowledge that I have read this application,Bled out in full the includes Temporary Service: (0 Yes 74.f.to
• information required,completed an accurate plot plan,and state that at
the information as required Is correct I agree to comply with the infor-
mation and plot plan,to comply with all Town ordinances and state laws, .Work Class:
and to build this structure -. . . to the town's zoning and subdivision €New(0) Addition OkRemodet(" Repair(C')
codes.design WWIIBuilding and Residential
and other.. Town spliced*thereto. ;Other(C))
X %
Owner/Owner's - - . Signature(Required) Type of Building: Single-Family(Q Duplex((
Multi-Famy Commercial(n Restaurant to
Other c.)
Applicant Name: . 0 ## /,�f
Applicant Phone: ff4 J .M ��- Provide (Labor Ma erials)footage of na worts
Applicant E-Mail: 0 M . /"MINrir,. 7 /
Amount of SD Ft.: ! .9..
Additional Users ' •"
Electrical$: r � Q_.52..._
Full Name:
E-Mail: ro-. • _rdb . S 1C r _c v'
Full Name:// �^ to t�C...
1 Date Received:
E-Mail: 't;�ovN‘ C.c.ell. r Ow
For Me Use Oily: . •
Fee Paid:
Received From:
Cash check#
CC: Visa/MC Last 4 CC# Auth#
Rev.2015-Dec