HomeMy WebLinkAbout4464 Brentwoood StreetFrom: no-reolvCalci.wheatridae.co.us
To: CommDev Permits
Subject: Online Form Submittal: PERMIT APPLICATION Electrical Service Change/Upgrade/Electrical Work
Date: Thursday, April 14, 2022 2:12:03 PM
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PERMIT APPLICATION Electrical Service
Change/Upgrade/Electrical Work
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 4464 Brentwood Street
Property Owner Name John Tufty
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"
303-503-6024
KES Elec Payment. odf
CONTRACTOR INFORMATION
Contractor Business Kelly Electrical Services, Inc.
Name
Contractor's License 020650
Number (This is a 5 or
6 digit number for the
City of Wheat Ridge)
Contractor Phone 303-202-5030
Number (enter WITH
dashes, eg 303-123-
4567)
Contractor Email
Jerri@kesonline.com
Address
Retype Contractor
Jerri@kesonline.com
Email Address
DESCRIPTION OF WORK
Is this an electrical
Change
service upgrade or
change?
Number of Amps
200
Location of work
Back of hourse
(garage, house, etc)
Provide additional
Service change - Overhead, Add exterior GFCI
details, if needed.
Project Value (contract
6000
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 Tim Holmes
Pe rm it
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