HomeMy WebLinkAbout1570 Blue Spruce Dr - Applications/Electrical - 07/31/2012Planning, Development & Transportation
F�� ,� 281 N. College Ave P.O. Box 5$0
or. 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) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
O Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement O'Roofing ❑ Sewer Line 13 Photo -voltaic
O Ventilation ❑ Water Heater ❑ Water Line O Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all appli
cable information on the application. Incomplete applications will not be accepted.
Appiieatiorf-# 1b Q 3_i,2� Qate 5 1 201L
For office use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
/67-
Pro Owner Name Address
City/State ZIP
Phone q?D-
3ppUqant Name Address
City/State Zip
Phone Q X3
a Address
Ziip�
Phone
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Contractor a of Ft. Collins Sales Tax # 171Lf�uh'-L
Are you paying taxes here or by report?
❑ Here eport
Sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? O Residential commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) O Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Mote}n ❑ MedicaJ.pffice Office ❑ Retail
❑ Restaurant ❑ Other (explain)/ r.c //. h.
Is this building 50 years of age or more? ❑ Yes O 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
*If lawn sprinkler/bacldlow 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: e L� VIA115f Print Name: signature Date
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