HomeMy WebLinkAbout1506 Knotwood Ct - Applications/Electrical - 12/16/2015Planning, Development & Transportation
Fort Collins _ 281 N. College Ave P.O. Box 580
Fort Collins,
CO 80524
Phone 970-41616-27402740 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 #
For office use only
Date
Job Site Address (required) II --
Value of Construction (labor, materials, profit)
50 p CT.
C;:'9_ 0L!P 0
Property pwner Name Address
City/State Zip
Phone 7a
Joe s Jck1 i-e 6e1 M6LA I50b lookwooc( L-�. 5n52-
2z-7 - 3-0
Applicant Name Address
City/State Zip
Phone 7 0
6 `(`( cika\�, l t 5-7
0 a t1 m , I C 1 . ?S z—�
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Contractor Address
City/State Zip
Phone C(70
6<(t;,,.kW 0-eck«
Sz9
Z2-1 —40
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? )Here ❑ Report
sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? I"esi(
If residential, is it: kkingle Family Detached ❑
❑ Multifamily (apartment) ❑
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑
ential ❑ Commercial
Condo/townhome (single family attached) ❑ Duplex
Garage
Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (ex am)
Is this building SO years of age or more? ❑ Yes PKNo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnbr to 1975, you will need an asbestos assessment to submit with this application.
Description of work UJ k \F i v. y d (A M k � 0( � � ti'P • :E�
A l t7 5 r Sit I e, � % �� a nn ; L4 room • C,Gt ,c-P S x),-o L( Ct
*If lawn sprinkler/backfow 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.
Print Name: l U CZ l�� � �� � Signature Date /
55
0