HomeMy WebLinkAbout833 S Taft Hill Rd - Applications/Electrical - 08/05/2013Cityof Planning, Development & Transportation
r } 281 N. College Ave P.O. Box 580
rOr` 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
❑ 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.
Application # 'f5 1 0C4
For offilce use only
Incomplete applications will not be accepted.
Date -0-13
Sob Site Address (required) Value of Construction (labor, -materials, profit)
33 ,5 �" � / �
Property Owner ame
City/State Zip
Phone
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icant Name
Address
City/State Zip
Phone
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Contra or Lic #
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Address
City/State Zip
Phone
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Contractor City of Ft. Collins Sales Tax
#
Are you paying taxes here or by report?ere
❑ Report
sales tax number is required by all contactors
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? ❑ Residential Asommercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ BariChurch ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building SO years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this Is for a demolition permit, what year was the building constructed?
If pnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontra o Lr the company name or City of Ft Collins license #
Electrician P LiO 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. A
Applicant: � U �/%r�C r
Print Name:GGGG-- D /' 1 / G
Date
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