HomeMy WebLinkAbout309 E Thunderbird Dr - Applications/Electrical - 10/14/2011Cit
of
F®ryt 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) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 0 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 # //// 7 :� -3 -7 -1 Date
For office use only xz-,�. �,
Job Site Address (required) Value of Construction (labor, materials,. profit)
309 s q00. oo
Property Owner Name Address
City/State Zip
Phone
/V
Applicant Name Address
City/State Zip
Phone'
I-w k 00 6L)o o d
ST r7_ Co lLys90,52
1 69 2- 36,55
Contractor Lic # Address
City/State Zip
Phone
13r a t`r M E- oo
S �"7" o
-
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 c mmercial project? [M, Residential ❑ Commercial
If residential, is it: Ell Single 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 (explai )
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 prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work Re to c_a lc_ AAe u) �1 ec tze a.,q pa'r-1- of i4h e_
C ,'+-Y o- �-�. C o l I 'ti .5 P o e%r- A r�, i s G� Q ,,w,v �',� �, n/ a P w e.y�
*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:
Print Name:-. til�k—e-- U/urV, k Signature Date