HomeMy WebLinkAbout532 Skyline Dr - Applications/Electrical - 07/16/2015City
of
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Flirt CoRins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
3-i 3, Q S
®VEWTHE-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 applicatio s will not a accepted.
Application # ,73) 450 5 J Date
For office use only
.fob Site Address (required)^
Value of Construct' (labor, materials, profit)
'Property Own r Na
Address
City/State Zip �� P e
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Ar plicant Name
Address
City/State Zip P
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Contr ctor
Address
City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by all contractors.
Are you paying with your trust account? ❑ Yes �o
Is this a residential or commercial project? Resi ntial El Commercial
If residential, is it: El Family Detached Condo/townhome (single family attached) El Duplex
❑ Multifamily (apartment arage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑❑?r (explain)
Is this building 50 years of age or more? Yes ❑ No If yes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what ear 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/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontr cc, !!/!tor$rc: List he company name or City of Ft Collins license #
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Electricia -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: Ltl���y�i �/Print Name: Signatur ate
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