HomeMy WebLinkAbout1316 Luke St - Applications/Electrical - 02/13/2012Planning, 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 Atterafion (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 # T? fegm 55 Date
For office use only
Sob Site Address
Value of Construction (labor, rnabuiats, profit),
/(required)
3
Property Owner Name
Address
City/State Zip
Phone
f
Applicant Name
Address
City/State Zip
Phone
Contractor
Address
City/State Zip
Phone
Y
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
O Here ❑ Report
Safer tar number6 rinwAred by aff aw&artom
Are you paying with your mist account?
❑ Yes ❑ No
Is this a residential or commercial project? 0 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 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Hrslolic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifjonor to 1975, you will need an asbestos assessment to submit wL69 this application.
Description of work
*If lawn sprinider/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins fiwnse #
Electrician
Mechanical Roofer
I hereby acknowledge that I have read this application and state that the above information is complete and coned 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. `
! l
Print Name: Signature ` pate