HomeMy WebLinkAbout1320 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 nonstructural) ❑ 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 # D [��01 -57 Date h'1��
Foro>ike use only
lob Site Address (required)
Value of Construction (labor, materials, Profit)
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Property Owner Name
Address
OW/State Zip
Phone
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Applicant Name
Address
Cary/State Zip
Phone
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Contractor
Address
City/State Zip
Phone
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Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report?
0 Here ❑ Report
salesraxnumb&-isregubedbyaffo=badars
Are you paying with your mist account?
❑ Yes ❑ No
Is this a residential or commercial project? 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 coniact Historic Preservation
If this is for a demolition permit, what year was the building conducted?
Ifpnar to 1975, you will need an asbestos assessment to submit with this application.
Description of work '✓t-e �i'r J r
*If lawn sprinkler/badcHow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the company name or Gty of Ft Co/Gns license #
Electrician Rumba 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:
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Print Name -�- Signature _ Date
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