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Home My WebLink About1917 S Shields St - Applications/Electrical - 07/21/2015To: Page 3 of 3 2015-07-13 19:31:02 (GMT) 19707971051 From: Michell Mclaughlin 01t+ Of Planninq.. Development & Transportatio€s 281. N. Coliege.Ave P.O. Box 5$Q Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-51.34 .C^�',� ` ,. c F- sjf -a r'.. +yw.re •p .i a ;,.,i „ t' This application -is to be: used:to.apply. for thQ •tb{loaiirtg. lesrliilts: only (chec6c'all that apply). .Air Conditioning O Demolition (interiornon-structural). ❑.Electrical Alteration.(not.service.change). O Gas Lighter U.Gas Log O Heating Unit. O Lawn Sprinkler O Mobile Home replacement: O. Roofing Q Sewer tine. la Photo -voltaic O Ventilation. ❑.Water.hfeater t7 Water Line, 0 Wood/Pellet Stove (must be. EPA certified,. provide make,.madel and manufacturer). complete all applicable information on the application. incomplete applications will not be accepted.. Application #_ . g 5 O 5 _LI 6.--_--- gate -7 For office use only 3ob:Site® Address (required) Value of Construction (labor, materials,.proilt) Property Owner Name Address city/state. Zip Phone Applicant Name Address City/State. Zip Phone ` " fir. '1 �'� .y,�`> ^y 1 q y �� , l��l✓f��.� \ia4j,�SCIf 'f'"f..l �'� � ___- _��-L�� r.• � . Contractor Address. City/State Zip .. . Phone Contractor City of'Ft: Collins Sal Tax # Are you paying taxes: tie re or.by report? .IM Here t7 Report Sr/esta};numbrisre9ulreiibya'Imntractors Are'you paying Paith`yourtrust :account? O.Yesl No Is this a residential or commercial project? 16 Residential O Commercial If residential, is it: ❑ :Single Family Detached U Condo/to4vnhome (single. family attadied) Duplex $X ^ iyltifamily. (apartment) O Garage: If cornmerdal, :is it:. O Bank O Ear O Church © Hotel/Motel ❑ Medical office 13, Office ❑ Retail Q. Restaurant Q.:Other.(explain).__�.� Is this building SO years of age or -more? [].Yes O No. .If yes, you.mayneed to confaet Historic Pre a vatiorl If this is for a demolition permit, what.year was the building conshlicfed? if prior, to 1975, ymi will need an asbestos assessment to submit with thisapplication. Description of lawn.sprinkler/bacJcHow:preventer; must.list licensed plumber. Yfirst-time AJC, rnust.list.11censed electridan. Subcontractors: UstthecompanynameorCityofFt. Collinsdicense.# Electridand _(%" T7`i Plumber.._._ Mechanical Roofer. Other. I hereby acknowledge:th.at.I have.. read thic.application and .state that the above information. is complete:and.rorrect: I`.agreP to comply with all requirements contained herein: and. cityordinances and state laws regulating building construction: T Im.ow that a perm'Us not valid uritil:It has been paid and Issued. Applicant, d Print Name.:Xs i { rCti; ty i9"l Signature date.'