HomeMy WebLinkAbout1300 Fairway Five Dr - Applications/Electrical - 01/14/2013City Of Planning, Development & Transportation
t 281 N. College Ave P.O. Box 580
` Collins Fort Collins, CO80524
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) IN Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ 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 # &I' o l u
For office use only
Date I^l7'1 J
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip Phone
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Applicant Name Address
City/State Zip Phone
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Contractor Address
City/State Zip Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
Saks tax number & required bya//contractors
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? I0 Residential ❑ Commercial
If residential, is it: 0 Single 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 ® No ff yes, you may need to contact Historic preservation
If this is for a demolition permit, what year was the building constructed?
ff prior to 1975, you w11/ need an asbestos assessment to submit with this app/fca6on.
Description of work_ Hdd t',o 2oq 2yoy raxeV.1,1 ,,. t Hr I Zay
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,a..,, aN,u,n,euuaucnow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins License #
Electrician Plumber
f admiral Fbofer
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 Name: 7- �- S'� rs Signature {/�
� /t Date /y 3