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HomeMy WebLinkAbout2920 Stanford Rd - Applications/Electrical - 10/31/2016Cot of . F6Y�t 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 # Ill/ �� Date 131 For office use only Job Site Address (required) Value of Construction (labor, materials, profit) q20 5T- F!d "�d• 1'�rTCvVi1zs CO vSzs O. ©v Property Owner Name Address City/State Zip Phone Qff,* ffiz kaId 2-12o S%nfoi RJ Fad_ 611"-15 62 g0SZ5' 97o-7fl-O)S/ Applicant Name Address City/State Zip Phone Ae 1r;e" SY/ - &da.D" awti. �Ilnjrolr CD gogw Q70-W-2osS Contractor Address City/State Zip Phone 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? O Residential ❑ Commercial If residential, is it: ,Single Family Detached 11 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. Jff 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 R4�./&<e_ eX;fii,., 4,f i, L= le�'Y,'c Air.%,ei *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 li'5Arewi VP 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: 1�� // / / J� Print Name: WGWY !/CirTihw, Signature ��— Date