HomeMy WebLinkAbout1321 Yount St - Applications/Electrical - 02/13/2012City of Planning, Development & Transportation
Fliram, { 281 N. College Ave P.O. Box 580
rt CoUg y� 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 ❑ 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 #_ _6) ,� 901R0 Date
For office use only
Sob Site Address (inquired)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip
Phone
Appliyc)ant Name Address
City/State Zip
P5(ione
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Contractor Address
Gty(State Zip
Phone
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�_ W,, ._ �i Ste; t.,� 3)
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Contractior Gty of Ft Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number is requedbyaamnrrarhys
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? )2f Residential ❑ Commercial
If residential, is it: 0 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 (explain)
Is this building 50 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?
Ifjonor to 1975, you will need an asbestos arse wnentto submit with this application.
Description of work
*If lawn sprinkler/badd low 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 g
8ectridan Plumber Med-anical 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 regUirernerrts 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: Signature
Date