HomeMy WebLinkAbout4610 Quail StreetFrom: no-reolv(alci.wheatridae.m. us
To: CommDev Pets
Subject: Online Form Submittal: Electrical Service Change/Upgrade/Electrical Work Permit Application
Date: Wednesday, December 1, 2021 1:35:57 PM
Electrical Service Change/Upgrade/Electrical Work Permit
Application
This application is exclusively for RESIDENTIAL ELECTRICAL SERVICE
CHANGE OR UPGRADE (200 amps or less).
YOU MUST ATTACH A VALID CREDIT CARD AUTHORIZATION FORM IN
ORDER FOR THE PERMIT TO BE PROCESSED.
Your Permit will be emailed to the email address provided below once it is
processed.
THIS APPLICATION DOES NOT CONSTITUTE A PERMIT. DO NOT BEGIN
WORK UNTIL PERMIT HAS BEEN ISSUED.
Is this application for Yes
electrical service
change or upgrade -
200 amps or less?
PROPERTY INFORMATION
Is this Residential or Residential
Commercial?
Property Address 4610 quail st
Property Owner Name Mike Wilkinson
Property Owner Phone
Number (enter WITH
dashes, eg 303-123-
4567)
Attach City of Wheat
Ridge Electronic
Payment Form - "DO
NOT ATTACH A
PICTURE OF A
CREDIT CARD"
720-277-6947
CONTRACTOR INFORMATION
Contractor Business Mike's Electric LLC
Name
Contractor's License
210299
Number (This is a 5 or
6 digit number for the
City of Wheat Ridge)
Contractor Phone
720-670-8934
Number (enter WITH
dashes, eg 303-123-
4567)
Contractor Email
MKahmElectricalService@gmail.com
Address
Retype Contractor
MKahmElectricalService@gmail.com
Email Address
DESCRIPTION OF WORK
Is this an electrical
Upgrade
service upgrade or
change?
Number of Amps
200
Location of work
House
(garage, house, etc)
Provide additional
n/a
details, if needed.
Project Value (contract
5200.00
value or cost of ALL
materials and labor)
SIGNATURE OF UNDERSTANDING AND AGREEMENT
I assume full
Yes
responsibility for
compliance with
applicable City of
Wheat Ridge codes
and ordinances for
work under any permit
issued based on this
application.
I understand that work Yes
may not begin on this
property until a permit
has been issued and
posted on the property.
I certify that I have Yes
been authorized by the
legal owner of the
property to submit this
application and to
perform the work
described above.
I attest that everything Yes
stated in this
application is true and
correct and that
falsifying information in
this application is an
act of fraud and may
be punishable by fine,
imprisonment, or both.
Person Applying for Mike Kahm
Permit
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