HomeMy WebLinkAbout413 Pearl St - Applications/Electrical - 04/22/2015 (2)t
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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) N 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.
Application # F) I 02 &H S — hGUs_C Date i 2 21.j
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Job Site Addr ss wired)
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Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zi Phone
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Applicant Name Address
City/State Zip Phone
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Contractor Address
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City/State Zip Phone q I D -
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Contractor City of Ft. Collins�Sales Tax #
Are you paying taxes here or by report? d Here E Report
sales tax number isre9ul�edbyall contractors
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Are you paying with your trust account? ❑ Yes 11 No
Is this a residential or commercial project? 0 Residential ❑ Commercial
If residential, is It: IN'Single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) Iff 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 Ifyes, you may need to contact Histolic 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
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❑ Duplex
*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
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: I ' J� \+v i Li I-t i g L .AAA_ ��
Signature ti sl ( l _ r Date