HomeMy WebLinkAbout1016 Cragmore Dr - Applications/Electrical - 07/07/2016City of
t Collide
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 # b, 005276;Z;k Date
For office use only
07/07/2016
Job Site Address (required)
Value of Construction (labor, materials, profit)
1016 Cra more Drive
$1,000
Property Owner Name
Address City/State Zip
Phone
Applicant Name
Address City/State Zip
Phone
George Stolz
3317 N Lincoln Ave Loveland, CO 80538
(970) 669-7609
Contractor
Address City/State Zip
Phone
Gregory Electric Inc
3317 N Lincoln Ave Loveland, CO 80538
(970) 669-7609
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? XResidential ❑ 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 50 years of age or more? ❑ Yes IKNo Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior. to 1975, you will need an asbestos assessment to submit with this application.
Description of work Service change on behalf of the City of Fort Collins L&P.
*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 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: l George Stolz Print Name: g Sig
Date
07/07/16