HomeMy WebLinkAbout2936 Council Tree Ave - Applications/Electrical - 02/16/2012Planning, Development & Transportation
cjCltry Of = t- _� 281 N. College Ave P.O. Box 580
t _ 0`��nS 1 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) ❑ Electdcal 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 an>^'
manufacturer). ` /
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 3/oP- 4 0 7- Date �)_'" I - D_
For office use only &C-O)
lob Site Address (required)
Value of Construction (labor, materials, profit)
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sZ5
Property Owner Name U Address
City/State Zip
Phone
CtS
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone203-7A91
co t [ �i S
T65i cW 0
Contractor City of t. Collins Sales Tax #
Are you paying taxes here or by report?
,J1 Here ❑ Report
Sales tax number is required by all contractors
KA 12�
Are you paying with your trust account?
❑ Yes &No
Is this a residential or commercial project? ❑ Residential gLcommercial
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 I�LRetail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes "o If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975; you will need an asbestos assessment to submit with this application.
Description of work�� jJj[}rl F' C-F
*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: P _!�
Print Name: l In�S l �,T_ Signature Date
0116