HomeMy WebLinkAbout2200 Ayrshire Dr - Applications/Electrical - 07/06/2017y
City of Planning, Development fit Transportatfwn
28P N. College Ave P.O Box 580
Fort Collins Fort Collins, C0 80524
Phone 970416-2740 Fax 224-6134 '
OVER=THE-COUNTER 'PERMITS -ONLY
This application is to be usetito apply for the following permits`oniy (check ail tfiat apply): ❑ Air Conditioning .
❑ Demolfion (interior nonstructural) ❑`Electrical'Afteration (not service`change)' ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit; ❑lawn Sprinkler ❑ Mobile Home replacement ❑'Roofing ❑ Sewer Line :❑ Photo -voltaic
O Ventilation 'O Water Heater' O Water Line ❑ Wood/Pellet Stove (must be EPA 'certffied,':provide make, model and
manufacturer).
Complete all appli le innff on an applioation. incomplete aPPliiiati `ns will not be accepted.
Application #' Tv .nL1�7' Date !�
For a—Ok;+ use only
Job Site Address (wired) Value of construcdoil (labor, materials,'Profit)
-Property OwnerName
Address
City/State Zip 61?hone
oZz
Oro
SAI12SE2
Applicant Name
Address
City/State Zip
Phone
Contractor
1Jc # gO f o Address
City%State Zip
e
ContradbrO of Ft Collins Sales Tax #
ty
Are you 11 Here
y paying taxes here or by report,
❑ Report
po
Sales tax nuirideresISO&A
Ybyallwnfiamws
Are you paying wtt:KOur trust account?' 0 Yes
❑ No
Is this a residential or co raaI project? ;Aiisidential . ❑m Com"I
If. residential, ts'it: Singli family Detached 0_ C,wido/tDomhome (single fatuity anadie'd) ❑ bLiplex
❑ Multifamily (apartment) O Garage
If commercial, is it: ❑ Bank ❑ Bar O hunch ❑-Hotel/Motel - ❑ Medical office ❑'Office ❑'Retail
❑'Restaurant ❑`Other (explain)
Is this building, ears of ng y age or more? ; O Yes E3,
No If yes, you may need to mntact H/stonc Prewrwifon
If:this is fora demorriion permit, what year was the building constnicbed?. _
If to 1975 prior , ynu wl//need an asbesws asz+swwrt to svbmlt rv/th thus app/let/on.,
Description of work O7J,y PjVZ 3C4011A,14Z,
:. spri /bacldiow.prim , must list licensed plumber. If first-time A/C, must licensed electrician.
*If lawn nkler
SuboontraeEura ; list the company nine or ayof'M C MIN /k&7W 0
bec r n Plumber Mechaniml RooW Other .
I hereby ackrwwledge.that I have reatl 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'Imow that a
permit Is not iWid'until:it has been paid and issued.
Applleant
Print Name: 8nature pate. .