HomeMy WebLinkAbout1043 Deer Creek Ln - Applications/Electrical - 08/16/2018City of Planning, Development, & Transportation Services
Fort Collins Community Development & Neighborhood Services
�- 281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apfor the following permits only (check all that apply). ❑ Air Conditioning
ply
❑ Demolition (interior non-structural) Electrical Alteration.(aet-sewiee-ehange)- ❑ 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.
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Application # \ For oce Date -16 -18
iuse only
Job Site Address (required) Value of Construction (labor, materials, profit)
Fn92`1 A IOu ZGFK CZECK (.rJ FOZ(COLLiAts CO 1 q%0- S`4
Property Owner Name Address City/State Zip Phone
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Applicant Name Address City/State Zip Phone
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Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Ig 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? 1% Residential ❑ Commercial
If residential, is it: 54 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 50 years of age or more? ❑ Yes ❑ No If yes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work iJP62RPiAlre loo(\YAP PA4e%- io Zoo kOAe PPASU i,)t-N I,SoA.kp MQ
*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# Ri\'%exieA,a &%.cc'MiCAL, W,Act�lto�j,lTij
Electrician C)i 0 o q 8q 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.
K'0)M,1LTZ BAQronl
Applicant: _
Print Name: CAM —I me l Z Signaturebo Date 'a' 1 O-+g
Revision date 216/2017