Loading...
HomeMy WebLinkAbout321 Urban Prairie St - Applications/Electrical - 07/30/2015©r Ciof '=t CoRins (Planning, Development € Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 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 # kJ � �V4J Date For office use only Job Site Address (required) Value of Construction (labor, materials, profit) evip,, S�3�1l��sie�il / sy S'71�, o� i�o '- �§g /..0a Property Owner Name Address City/State Zip Phone a &1L-r16S Uc & 72o ammL 0 • �V 595' -KO% Applicant Name Address City/State Zip Phone o _ ai6 r l A AJIA20C Contractor Address City/State Zip Phone E%F ie/ (r. LAG �WOPT 0TUO ', . ,U14,0'? 42) 95,57-2 `�1�567 Contractor City of Ft. Collins Sales Tax Are you paying taxes here or by report? V Here ❑ Report sales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes 1UI No Is this a residential or commercial project? ❑ Residential (�1, Commercial If residential, is it: ❑ Single 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) EDA-V 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? Ifprior to 1975, you will need an asbestos assessment to submit with this application. Description of WI *If lawn sprinkler/back low 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 1776 (J2,5 Plumber Mechanical Roofer Other I hereby acknowledbe 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 flame://I7 /i/dGf//l� Signature Date