HomeMy WebLinkAbout806 Pear St - Applications/Electrical - 04/09/2012City Of Planning, Development & Transportation
Fort_ 1 Collinsor N. College Ave P.O. Box 580
~n`'�-i ` 1 '.7 Fort Collins, CO 80524
Phone 970-416-2740 Fax 22+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 # l Z10 I SD4
For office use only I cb
Date
Sob Site Address (required)
Value of Contra on (labor, materials, profit)
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-V `is (5, 0d
Property Owner Name Address
City/State Zip
Phone
Applicant Name Address
City/State Zip
Phone
'
CO ea—*?
ftl-z/d-671
Contractor Address
City/State Zip
Phone
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, // . Jji 6,l G O cg�V
Z /`/ 6
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report? -6KHere
❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account? ❑ Yes
❑ No
Sd �t>•to
Is this a residential or commercial project? X 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 4 No 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 CGtQA,,c , %Pa.h rf'/ w.. cza.r.-r,r —
*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 Mrt — -"a S % 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:
Print Name: ��cL,t� Signature