HomeMy WebLinkAbout613 Justice Dr - Applications/Electrical - 08/07/2020Fart of
Community Development and Neighborhood Services
281 N College 970-416-2740
Fort Collins, CO 80524 buildingservices@fcgov.com
Application # R /_ V V D ®`7 S—
Date Received
Job Site Addr s
Address ��� "yS� r ('- " ! City/State/Zip f f- COl 1 t(AS Cll , �a26
Property Own r Information
//' �i C c
Name �I/ �lii(``/� (�J l l/)�C�� Phone Numbery ✓ 2
Address 6 JC/i L I/ City/State/Zip Ft Coll�1�1s Ld, �j�YZ6
■Single Family Detached QTownhome (attached) Q Duplex QApartment/Condo Q Garage/Other
• Q Bank Q Bar Q Church Q Hotel/Motel Q Medical Office Q Office Q Retail Q Restaurant
Value of Work
Labor and Materials $ 150
Or VVOrK
Q Panel change out Q Meter change out Q 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 OltI?
Service Upgrade Q Yes M No
Existing Amps
New Amps
Additional Information
(if applicable)
Electrical ContractorInformation 1
Name NI ( A Q
Address
Phone Number
License Number ME -
Email
City/State/Zip