HomeMy WebLinkAbout1433 Pikes Peak Ave - Applications/Electrical - 03/27/2012Po
City O� Planning, Development & Transportation
Y 281 N. College Ave P.O. Box 580
�F®rt dhns � Fort Collins, CO 80524
�.- Phone 970-416-2740 Fax 224-6134
0"VE -THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only check all that apply). ❑ Air Coriditionin
pp PP Y 9 p Y( pp Y)• 9
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) . ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit 0 Lawn•Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑Sewer Line ❑ Photo -voltaic;
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA. certified, provitle make' model and
manufacturer). t ^
Complete all applicable information on the application. Incomplete applications will not be accepted2'
Application ,# Date
For office use only
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Job Site Address (required) Value of Construction (labor, nJaterials,,profit)
Property Owner Name Address
City/State Zip
r
'JPhone
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Applicant Name Address
City/State Zip
Phone'
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d ST CT Co ILys905.11 69 -
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Contractor Lic # Address
City/State Zip
Phone
13r a c M E- '-1
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
O Here ❑ Report
sales tax numberisrequiredbyall contractors.
Are you paying with your trust account?
AD Yes ❑ No.
Is this a residential or�cqmmercial project? Eff 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 ❑ RetiA-
❑ Restaurant ❑ Other (explai )
Is this building 50 years of age or more? ❑ Yes MNo If yes, you may need to contact Historic Preservation 4
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
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-*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.
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Applicant:
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Print Name:-. wk-� UWrK. Signature " �_ Date