HomeMy WebLinkAbout640 S Shields St - Applications/Electrical - 09/16/2020City of
Frt Collins
Community Development and Neighborhood Services
281 N College 970-416-2740
Fort Collins, CO 80524 buildingservices@fcgov.com
Application #
Date Received
ALL information is REQUIRED. Incomplete applications will not be accepted.
.. Site Address
Address •
Property Owner Information
Name 0e eo,iI Phone Number
4Address `-f o S V Zvi(d �f ��. City/State/Zip
e 0 Single Family Detached Q Townhome (attached) Q Duplex o Apartment/Condo Q Garage/Other
® Q Bank O Bar O Church O Hotel/Motel O Medical Office O Office O Retail O Restaurant
Value of Work
Labor and Materials $�
Scope of Work
O Panel change out O Meter change out O Upgrade existing wiring
Q Panel Upgrade (May require additional review time. A commercial panel upgrade of 225A or 3 phase requires a 1 line diagram.)
Other electrical alterations I 1 eel-* L
Service Upgrade Q Yes (21 No
Existing Amps
New Amps
Additional Information
(if applicable)
Electrical Contractor Information
Name I `s <—
Address jgZ0 6(,,z J-_, cQ PJ�
Phone Number Email
License Number ME- e.3 3
4-1
City/State/Zip j=F(p/(,<J C<) k . —> -(
Print Nam �L I A't e-!`� Signature Dat�-�� i,