HomeMy WebLinkAbout1030 Strachan Dr - Applications/Electrical - 09/03/2015r ,^
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) ❑ 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 # F� 150 &6&2; Date 91 � j115�
For office use only
Job Site Address (require
Value of Constru�ipn (labor, materials,
profit))
I C_Y'L'x-L
`�I o
Property Owner Name
Address
City/State Zip
Phone
`��Ns
ego 5�2wcw
6-aa7-s
Applicant Name
Address
City/State Zip
Phone
C,�t .,-> E
SA k&
``
KE iO �E1 C S b5 U
b O 8 -'-
Contractor
Address
City/State Zip „
Phone
6_16-CA4xin S
Contractor City o Ft. Collins Sales Tax #
Are you paying taxes here or by report? XrHere
❑ Report
5alestax number isrequired byall contractors
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? ,❑ Residential ❑ 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)
Is this building So 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 work
*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 PIE / 620'W 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: Ce-Ta 4) ALi wAL Signature
Date 9 3 IS
,sa
I�::7