HomeMy WebLinkAbout1620 Smith Pl - Applications/Electrical - 11/22/2013City of Planning, Development & Transportation
Y 281 N. College Ave P.O. Box 580
Fort 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. Incomplete applications will not be accepted.
Application # a l� U Q� 9 S Date I l l _221 13
For office use only
Job Site Address (required)
V ue of Construction (labor, materials, profit)
o ~
Property Owner Name Address
City/State Zip
Phone
Applicant Name Address
City/State Zip
Phone9
Contractor Address
City/State Zip
Phone
^
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
'Wes tax number Is requ#rd by all contractors
Are you paying with your trust account?
❑Yes i7 No
Is this a residential or commercial project? W Residential ❑ Commercial
If residential, is it: Single Family Detach ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar 0 Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 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?
Yprior to 1975, you will need an asbestos as-cessment to submit with this appl/catfon.
Description of work
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: licit the company name or Cry of Fe Collins Ikense #
Elecoidan Plumber Mechanleal 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.
Appllcant�
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