HomeMy WebLinkAbout413 Pearl St - Applications/Electrical - 04/22/2015Fort Collins
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Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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) IX 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 a/prplic tions will not be accepted.
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Application # ,V J 5 d2 9 H S — hGUS-C Date
For off/ce use only ?, i : (n g U /^ -A rn M /a_P
Sob l Site Addr ss (squired)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zi Phone
Applicant Name Address
City/State Zip Phone
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Contractor Address
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City/State Zip Phone ° 10 "
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Contractor City of Ft. Collin�)Sales Tax #
Are you paying taxes here or by report? d Here pReport
Sales tax number is re ulredbyallconbactom
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Are you paying with your trust account? ❑ Yes I&No
Is this a residential or commercial project? lF Residential ❑ Commercial
If residential, is it: IN'Single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment)
If commercial, is it: ❑ Bank ❑ Bar ❑ Church
IfGarage ❑Duplex
❑ 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 Histonc. preseivabon
If this is for a demolition permit, what year was the building constructed?
Ifprior to 197.5, you will need an asbestos assessment to submit with this application.
Description of work 0-1
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: 1-15t 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: CI N a'i W l o I \' \ 7 n Print Name: , H"' Signature Dateii
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