HomeMy WebLinkAbout3101 Swallow Bnd - Applications/Electrical - 01/23/2013City of
Flirt Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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) RkElectrical 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 # 3 / ? e-0 ::� - Date ;Jan z 3, a D 13
For office use only
Sob Site Address (required) 31 D / wQ(/ew alue of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip
Phone
D-iz la 's F Gt_c. Je— Fo Box
IH2 LI Co o n
o - 34-I I
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here tKReport
saiesraxnumber&requiredbyallconrractors.
Are you paying with your trust account?
❑ Yes 1,;<No
�9 �1 C)
Is this a residential or commercial project? XJ Residential ❑ Commercial
If residential, is it: gSingle 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 )4 No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List ffie company name or City of Ft Collins license #
Electrician ME _ 2e 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: I 1
Print Name: M i Ia Signature Date z3
833