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HomeMy WebLinkAbout3349 Dunbar Ave - Applications/Electrical - 02/16/2012Cit ForYt Collins 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 PERMITS ONLY This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning O 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 # h 1 (.0s Date, For office use only S Sob Site Address (required) Value of Construction (labor, materials, profit) 33fA 1) LhLg mL A-vf- r- t; . So qZ G $ 1 t h 6 0 Property Owner Name Address City/State Zip Phone. ph✓i, soSStr�-( 33fa ��n�f+Q �y F_C. cn 8of `ice, s6 .22 ApplicanMam !-f GCS Address City/State Zip Phone ((( (i kPP'( TA Al C5 LV F c Cc go 5-2f Q14-V (f -7 Contractor Lic # Address City/State Zip Phone SIpk re_GfC, A4966 z(lt Wpf I%SW FC-4 o ig05-2-4 2�¢, Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here Report Sales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes ❑ No Is this a residential or commercial project? M 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 ❑ Other (explain) Is this building 50 years of age or more? ❑ Yes 59 No If yes, you mayneed to contact Historic Preservation If this is for a demolition permit, what year was the building constructed? if prior to 1975, you wi/l need an asbestos assessment to submit with this application. Description of work A© Df,,)b i- (G t-( T S 24 m u T L C 75 C,> G 442* 6 *If lawn sprinkler/backflow 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 # Electrician 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: n 1 ,�— Print Name: D ( IFCI'rT Date Signature .. `" �U/ll