HomeMy WebLinkAbout5327 Jonathan Ct - Applications/Electrical - 08/25/2016City of
Fort Collins
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 # IUo"P� • Date &rx- 2s. 2oA...
For offlce use only
3.ob Site Address (required)
Value of Construction (labor, materials, .profit)
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-29
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Property Owner Name
Address City/State Zip
Phone
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Applicant Name
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Address City/State Zip
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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?
pHiLfflre ❑ Report
sales tax number is required by all contractors. Are you paying.with your trust account?
❑ Yes ❑ No
34� q 5W
Is this a residential or ccoTpercial project? tesidential ❑ 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? es ❑ 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 5A!2�Age . ✓� /a v �e e %c ��r� C�1
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*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 his
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: v 1 y /2
Print Name: � r ljj/ (�/ 2A�dslignature
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