HomeMy WebLinkAbout1024 Skyline Dr - Applications/Electrical - 08/10/2016Planning, Development & Transportation
City/ Of 281 N. College Ave P.O. Box 580
Fort Collin8 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 #
1!-,l 1004 (e to
For office use only
Date 08/10/16
Job Site Address (required)
Value of Construction (labor, materials, profit)
1024 Skyline Drive, Fort Collins CO 80521
$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? LXResidential ❑ 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 )( No If yes, you may need 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.
(FnrPman = Jim StorPhn 97n 918 9928)
*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: nature George Stolz Si Print Name: g
Date 08/10/16