HomeMy WebLinkAbout1408 Meeker Dr - Applications/Electrical - 06/21/20121 Sao 0000, 5339y9. 36410. 15a0a3 69C
p�1 Planning, Development & Transportation
®1 �y of
�®��fY A� 281 N. College Ave P.O. Box 580
Fort Collins, 16 824
Phone 970-416-274740 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) ❑ 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 # 11�) Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
1yW 0,8 N1ee-leer Dr, 00 ,00
Property Owner Name._
Address
City/State
Zip
- Phone .
Applicant Name
Address
City/State
Zip
Phone'
J_mke ttAtrLk 700
tcloocl Sr FT. c0 1%A/.s 80,Sc2
1
6'9a - 36 55
Contractor Lic #
Address
City/State
Zip
Phone
Dr ow GdLrreif M E - 1o2 t-19
R35
1000 f S r-4. c o ll.ws
8a5-� 1 56 to - 70 A16
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or
by report?
❑ Here ❑ Report
Sales tax number isrequlredbyall contactors
Are you paying with your trust account?
❑ Yes .. ❑ No
Is this a residential or commercial project? 6d Residential ❑ Commercial
If residential, is it: V Single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Restaurant ❑ Other (explain) -
0 Duplex
❑ Retail
Is this building SO years of age or more? ❑ Yes tdNo if yes,; youpay need to contact Historic Preservation
If this is for a demolition permit, what year was the building constr''Oe'd?
if prior to 1975, you will need an asbestos assessment to submit;with",h 's application.
Description of work Ke / o c ou+ee
stir_ C, Iy bP Ffi. Coll:'..
lc. Me_4ef w
*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
G
I hereby acknowledge that I have, read this application' and state that the above in ns com -iplete and correct. I agree to
comply with all requirements containof rmatlo
contained herein and city ordinances and state -I wa s regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: LL / f
Print Name: �µne �jinJ fw i` Signature/"� L4 Date(-