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HomeMy WebLinkAbout512 E Monroe Dr - Applications/Electrical - 08/15/2016City Of Planning, Development & Transportation 281. N. College Ave- P.O.. Box.580 Fort C0—Urns 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 # i'>1lo�-7 I o-z For offlce use only Date 8/15©b Job Site Address (required) Value of Construction (labor, materials, profit) S1 a E: M L/a /noo, — Property Owner Name Address City/State Zip Phone f-, la . <�c6 Applicant Name Address City/State Zip Phone -P-S JDoS w.1u,A « V C_ Co 6�S'-�1 9?v 3C-q� Contractor Address City/State Zip Phone C c.\\ C+`�,VXr^ S . ';� . C . Co 65a 1 - S `-lb Contractor City of Ft. Collins Sales Tax # Are A paying taxes here or by report? `Q'Here ❑ Report sales tax number is required by all contractors Are you paying with your trust account? ❑ Yes �Q' No Is this a residential or commercial project? 'Residential ❑ Commercial If residential, is it: mingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) 1 Garage If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building 50 yea'rs 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 *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• \� o Print Name: GC Date v 1 1 5/ 0 L)31