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HomeMy WebLinkAbout300 Annabel Ln - Applications/Electrical - 11/11/2014City of Iff Fort CoWns Planning, Development & Transportation 281 N. College Ave P.O, Box 580 Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 �11l`f`f`fL L. ! n-^ •�* (�'.�� •r.- 1—o- � {J � �,L '. -Y" 7il ■ L i� )(- k ` 1� Imo. /L 4..' I •�6 � I }i IM- 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 # 1'J�`'{ �� ZJ Date # //-//- For office use only Job Site Address (required) Value of Construction (labor, materials, profit) �� 300 . tiAv�ie D© Property Owner Name Address City/State Zip Phone Applicant Name Address City/State Zip Phone tvt ,✓rit h 700 000d sI- '70 d Contractor Address City/State Zip Phone Qr rre PO o RO J 4), 56 7o 1-16 Contractor City of Ft. Collins Sales Tax # sales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes ❑ No Is this a residential or c mmercial project? f Residential El Commercial If residential, is it: gSlhgle 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 []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. of work a f _"/ *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 M �. ' 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. PrntName: Ulkt 1�tirwh c %/��� ll'-H--8Z Signature Date