HomeMy WebLinkAbout1221 Alford St - Applications/Electrical - 10/14/2011Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
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- C] Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer). 450
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # � � Date /O — /�J — / I i570_0
For office use only
Job Site Address (required) Value of Construction (labor, materials, -profit)
I�al A! -Fort ST s qoo. 00
Property Owner Name Address
City/State Zip
Phone
/VZA
Applicant Name Address
City/State Zip
Phone,
1- u, k o 0- Oood
ST FT ,' 00,52
1 io 9- 5
Contractor Lic # Address
City/State Zip
Phone
Sra r-r AAE- y oo
S -F"7 D
-
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or mmercial project? IN( Residential ❑ Commercial
c
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) 0 Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explai )
Is this building 50 years of age or more? ❑ Yes 19 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/backflow 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 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' N1i��
Print Name:.- bl�tc-� Ul��l. � Signature Date