HomeMy WebLinkAbout505 S Shields St - Applications/Electrical - 04/21/2014Fort Collins
Planning, Development 8c 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) M 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 # Date 4/21/14
For office use only
Sob Site Address (&vuired)
Value of Construction (labor, materials, profit)
505 South Shields St
0 O z)
Property Owner Name Address
City/State Zip
Phone
7-Eleven 1722 Routh St #1000, Dallas, TX 75201
Applicant Name Address
City/State 5•5I ocoo Zip
Phone
Arrie Oliver US Permit 117 Hurt Dr SE, Smyrna,
GA 30082 P: 770.433.0169 E: arrieoltver@uspennit.net
Contractor Address
City/State Zip
Phone
Legacy Electric 80 Talamine Ct, Colorado Springs, CO 80907
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
sales tax number Ismquhedbyall mnbacras
Are you paying with your trust account?
❑ Yes ❑ No
is this a residential or commercial project? ❑ Residential ® Commercial
If residential, is it: ❑ 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 M Other (explain) Mercantile -- Convenience Store
Is this building 50 years of age or more? ❑ Yes O No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you W11 need an asbestos assessment to submit with this applicaiyon.
Description of work Relocate or install (4) outlets at sales area Inside of exaiIerrep I%WIV rdetts,�. F%FR%.
SHALL BE IN COMPLIANCE
*If lawn sprinkler/back iow preventer, must list licensed plumber. If first-time A/C, musG�isO Haeosad�leadid aT N.��►
Subcontractors: List the company name orCYty of Ft Collins license 0 1� � �1 � 17� �YRRG�
Electrician Legacy Electric 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: Arrie Oliver signature- —Date- 04/21/14