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Xcel Energy - <br />APPLICATION FOR GAS AND ELECTRIC.SERVICES <br />Please photocopy both sides of this page fog- multiple use. <br />Date <br />SERVICE ADDRESS' <br />House or Fire Number <br />City <br />1--C7VlSvl1-1.E <br />Urban <br />www.xcelenergy.com <br />Full Street Name <br />SSTW ESN RboSe-VE.-T 'NYE. • '` 6I6,1'14 <br />Subdivision Name <br />Lot Number <br />Block Number <br />County :50VLD- <br />Phone: 1-800-628-2121 Fax: 1-800-628-2521 <br />Rural <br />County <br />Township' <br />Range <br />Section <br />State Zip <br />VO47-A.C,C) EX)o2-1 <br />Direction to service location (Rural required) <br />Cross Street/Road •$ESTWEXN P-COSS.VS.T AVE. • qt•-rt-I t - E.-T SouTH ! M.NRQHY Rihr-3 <br />SoBD►vtglvN NORTH Op TWE VN- PL.tm-r-r c=:• vla.¢mr'1BOu2.C. 'FAG -i 1 • <br />ONSTRUCTION INFORMATION <br />Owner Information (Party to be billed for service) <br />Owner Name CMTf O z t.�u►Svtt,t_>:. <br />Mailing Address •71-141 t- AUJ T. <br />City t.duLSv tt..t.'E State CO Zip Px7027 <br />Phone Number (303 ) 33S —'t735 <br />Contact during construction \Gi4Ti•4Y 1C.20N <br />Address 711 [RAIN) ST. <br />City I-0 State_ Zip goo27 <br />Daytime phone (30 3 ) 3'S5 ' LOS Lo <br />Fax 3 ) 33S 413>� <br />Cell/Pager (72b ) la41 - 2511 <br />E-mail Keoakt* GI . IrDu\4-4v1.1..6. <br />Contractor Information (include phone number) <br />General Contractor 00T `f-T F.t 1~GTE•P • <br />Phone Number ( <br />E-mail <br />Heating Contractor <br />Phone Number ( <br />E-mail <br />Electrical Contractor <br />Phone Number ( <br />E-mail <br />) <br />A&EFirm <br />Phone Number ( ) <br />E-mail <br />Required services: <br />ICJ Electric. <br />Electric Service <br />❑ overhead 11" underground <br />Service size (amps) <br />0 Gas <br />❑ single phase lEthree phase Voltage bt? <br />Is mporary electric service needed? Ei Yes <br />IE'single phase ❑ jthree phase 0 at pole <br />❑ at transformer SS other TO SE.-17S-Ft,QMt�i;P <br />arm twtA.etE <br />Date needed wOOrige .ivR_ /20Q _ <br />1 <br />Date basement to be dug / /20 <br />Cs3New <br />0 Relocate <br />Gas Service (For gas service, please fill out second page <br />of application.) <br />is this service being used for primary heat? <br />❑Yes ❑No <br />Total gas load (BTUs/hour): <br />Pressure 0 6 or 7 inch 0 2 Ib <br />0 10 Ib (commercial only) 0 Other <br />/ /20 <br />/ /20 <br />❑Yes ❑ No <br />Date needed <br />Date basement to be dug <br />COLORADO ONLY: EFV requested <br />FACILITY INFORMATION ' <br />Foxe-Nr— --7 Building Type 0 single home <br />Building Class ❑ residential <br />0 farm <br />Building square footage Building setback from property line (feet) <br />Electric Meter location preference (when you are facing the front of the house from the outside) 0 on house 0 on garage <br />❑ right side 0 left side ❑ front 0 other Feet from front corner <br />Gas. Meter location preference (when you are facing the front of the house from the outside) 0 on house 0 on garage <br />❑ right side 0 left side 0 front 0 other Feet from front corner <br />❑ duplex 0 multi-dwelling/no. of units ❑ commercial bldg. 0 mobile <br />0 commercial <br />For Commercial <br />Total motor load HP Largest HP Code BTU input <br />