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HomeMy WebLinkAbout1931 Dorset Dr - Applications/Electrical - 04/05/201304/05/2013 15:34 FAX Z001 Fort Collins Planning, Dewelopment ✓3: Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone M-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). 17 Air Conditioning ❑ Demolition (Interior non-structural) 13 Electrical Alteration (not service change) ❑ Gas lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler 4 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 # 1301ISC7, t _.. Date L/�13 For oft.- use only Job Site Address (required) Value of Construction (labor, materials profs) ml o .` Property Owner Name Address City/State Zip Phone 062 ( Applicant Name Address city/state Zip Phone C. r "C5 C.m YO 6 Contractor Address City/State ZIP Phone C o- Contractor City of Ft Colil s Sales Tax # Are you paying taxes here or by report72*�Here ❑ Report Saks taxnumber/srequlrtdbyallmntraLtxr Are you paying with your trust account? ❑ Yes 4 No Is this a residential or commercial project? Residential ❑ Commercial If residential, is it: '�El Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, Is it: ❑ Bank ❑ Bar © Church ❑ Hotel/Motel ❑ Medical offict; ❑ Office 0 Retail ❑ Restaurant ❑ other (explain) Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you mayneedt�2 cont3aH6twTcPteservatlon If this is for a demolition permit, what year was the building constructed? Ifprlor to 197$, you wilt need an asbestos assessment to submit with this app/iratio.,. Description of work El *If lawn sprinkler/baci flow preventer, must list licensed plumber. If first-time A/C, must list licensed elettriciem. Subcontractors: list Uie company name or oty of Ft Collins license g 011triclan Plumbs 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 Date � S a Print Name: 1 � ��,�j „ � �,� Signature� so WOS