HomeMy WebLinkAboutE16-0106.pdf = ¢'' Department of Community Development
; • 75 South Frontage Road West
TOWN OF v Tel 970-479-2139
www_vaiIgov.com
ELECTRICAL PERMIT
Electrical Permit Submittal Requirements Including Heat Tape Installation
Floor plan I 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 Street Address:
mmt.)p4ov vim:
Project#:
umber) (Street) (Suite#) Building Permit#:
Building/Complex Name:( 17f. ,(�'
`' Electrical Permit 4:
Project Information: _
Owner Name: X ( 7{1. •�G ,;
Lc": Block# Subdivision:
Parcel#2-k, 12-3 04-Cb/ - (2-'6,
(For Parcel#,contacTEagle County Assessors Office at(970)528-8640 or visit Define Scope and Location of Work: 6ierb—oe?-/Op—
www.eaglecounty.us/paUe)
Contractor Information
x/14 / �o �4L. -----64j4- W t rte
Business Name: � -G� �l�-
G f r�_
Business Address: r �' �� _F ��'��� �� ��
City 7pfl State: e;0 Zip:{ /lr32- /r."--,00_ --47-i) 4k (
Contact Name: Ilii + �Ir74-jam
Contact Phone: 63 �4f " �
A�, (uso a.•''onal sheet if necessary)
Contact E-Mail: , _ f- 1' '' - /1 i-
I hereby acknowledge that 1 hf e'cad this application,filled out if full the Includes Temporary Service: ( )Yes (l/No
information required,completed an accurate plot plan, and state that all
the information as required is correct. 1 agree to comply with the infor- F
mation and plot plan,to comply with all Town ordinances and state laws, Work Class:
and to build this structure according to the town's zoning and subdivision New( ) Addition( ) Remodel(repair( )
codes,-design review approved,International Building and Residential
Codes and they or.inances of the Town applicable thereto. I Other( )
7
X °�f ��„ a _______
I Type of Building: Single-Family( ) Duplex( )'
Owner wners Repr ntative Signature(Required)
Applicant Informati Multi-Family(Commercial( ) Restaurant( )
pp 1 til r Other( )
Applicant Name: d � S
I Provide BOTH square footage of area of work •
Applicant Phone: z3 '® `� �j0 ,v R AND Valuation (Labor&Materials)
Applicant E-Mail: -ea " 1 •�'I/'- - (Amount of SQ Ft.: e
Additional Authorized ProjectDox Users
..Electrical$: l t e::2/7
Full Name: j
E-Mail:
Date Received:
Full Name:
E-Mail:
'For Office Use Only:
Fee Paid:
Received From:
Cash Check#
CC: Visa/MC Last 4 CC# Auth #
Rev.2015-Dec
1 -