HomeMy WebLinkAbout1301 Luke St - Applications/Electrical - 02/13/2012Flirt CoWns
of
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 PERMfTS ONLY
This application is to be used to apply for the following permits only (check ell 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 # o�� �a,� Date
For office use only
3obSite Address
Value of Construction (labor, materials, profit)
�(required)
1q}
l
Property Owner Name
Address
City/State Zip
Phone
Applicant Name
Address
City/State Zip
Phi,one
A.' r
Contracbor
Address
City/State Zip
Phone
Contractor City of FL Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
sales tax numaertsrego edbyaamnrractus
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? g Residential ❑ Commercial
If residential, is it: OSingle 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 (explain)
Is this building 50 yearsof age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Pres&whbn
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment submit with this application.
Description of work
*If lawn sprinider/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electridan.
Subcontractors: List the company name or Gty of Ft Collins license #
Bectritian 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 conduction. I know that a
permit is not valid until it has been paid and issued.
Applicant:
Signature
Print Name: .<,s. -- Date
i,