HomeMy WebLinkAbout300 Yale Way - Applications/Electrical - 09/13/2012Planning, Development & Transportation
City Of 281 N. College Ave P.O. Box 580
Flirt Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log C
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic V
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # ?:�) 1�;)' (9 5 5-(o Date „ — Z �l
For ofte use only i!:
Sob Site Address (required)
Value of Construction (labor, materials, profit)
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-4D« co YbaD .315CA-032
Property Owner Name Address
City/State Zip Phone
shag, -V► tcL 300 C'k- Ub
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Applicant Name Address
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City/State Zip Phone
CO
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Contractor Address
City/State Zip Phone
U C tolJAraArtu,,64-0
01160L ea ssu
Contractor City of Ft. Collins Sales TaX4
Are ou paying taxes here or by report? Here ❑ Report
sales tax number is required by all mntracitim
Are you paying with your trust account? CrYes ❑ No
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: CSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes O No if yes, you may need to contact Histon'c PreservaG'on
If this is for a demolition permit, what year was the building constructed?
if pnor to 1975, you wilt need an asbestos assessment to submit with this arptirabon.
*If lawn sprinider/backRow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L46Y Me company name or City of Ft Collins license ,#
Electricianl Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant:
Print NameTT lei �J Signature S v` Date "j «- JZ-
T 40 T a6ud 1SIN ZTOZ TZ:OT:60 £T daS nqi 8T9Z'Z69'OL6'T JaS LV0LX0aL3 dp ua1g6L3 wou3