HomeMy WebLinkAbout2408 Orchard Pl - Applications/Electrical - 06/10/2014Jun 10 1409:09a Mac Electric Company Inc
970-669-6271 PA
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Fort Collins
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 r the following permits only (check all that appty). ❑ Air Conditioning
O Demolition (interior non-structural) ectrical 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 # fz1 -0112P, Date 6(o II 7 % am'q
For ofte use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
city/State Zip Phone
dri- i
Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
aar�
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report? )$Here ❑ Report
salesmxnumber Asregw-edbyaffcmptrz xs:
Are you paying with your trust account? ❑ Yes ,$1Qo
Is this a residential or commercial project? ,Wkesidential ❑ Commercial
If residential, is it ;KSingle Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage .
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
In• = r.
❑ Restaurant ❑ Other (explaln
Is this budding 50 years of age or more? ❑ Yes XNo Yyes, you may need to contact Ifcstoric Preservadon
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, yvu MY need an asbestos assessment to submit with this aopHcatva
of work
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*If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name orOYyofFtCollinslicense#
SectridanMA-774 Plumber Mechanical RDafer
Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct I agree tD
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit Is not valid anti) it has been paid and issued.
Applicant: `�
Print Nameilyda grLo'L Signature