HomeMy WebLinkAbout409 E Prospect Rd - Applications/Electrical - 06/06/2017& Val
artCollins
Call for Pa�ment
Planning, Develo men4 & Transportation Services
Community Development 8h Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970 4162740 Fax 970.224.6134
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) Jg Bedrical Alteration (not service change) ❑ Gas Lighter ❑ GasLog
❑ Heabng Unit ❑ Lavin Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Peflet Stove (must be EPA certified, prcmde make, model and
manufacturer).
Complete all applicable Information on the application. Incomplete applications will not be accepted.
application # d 1-1b30ZI Date 4/4P //'Z
rar a weof*
lob Site Address &eWred) Value of Construction (labor, materials, profit)
409 East Prospect Road $1500.00
Property Owner Name Address aty/Slate Zip phone
Celeste Magnuson 409 E. Prospect Rd Fort Collins, CO 80525 970-481-9102
Applicant Name Address City/State Zip phone
Leroy V Rios 3757 Dalton Dr. Fort Collins, CO 80526 970-420-507
Contractor Address City/State Zip Phone
Blueline Electric 3757 Dalton Dr. Fort Collins, CO 80526 970-421 -507
Contractor City of FIL Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
_QL4wf rnLnnk r,SregL edbra#crbraar hs Are you paying with your trust account? ❑ Yes ❑ No
49288
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, Is it: ❑ Single Family Detached ❑ Condo/trnmhome (angle family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, isFt ❑ Bank ❑ Bar ❑ Church ❑ Hobel/Motel ❑ Medial office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain) Is
ttds building 50 years ofage or more? ❑ Yes 0 No IfyNs, MunWfAeedtoconbdH&olfcPresa wifo i
If this is for a demolition permit, what year was the burkringmnstrud=17
Description of work Electrical Panel upgrade from100 amp to 150 amp
*If lawn spdnlder/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed eleciaician.
Suboontractorric List die cvimmny name or Gly of Colbns #a°f m a?
Bectridan ME-1187 Plumber Mechanical poorer Other
I hereby acknowledge that I have read this application and state that the above information is complete and oonecL I agree to comply
with all requirements contained herein and city ordinances and state laws regulating building construction. I kutow that a permit is not
valid until It has been paid and issued.
Applicant:
Print Name: Leroy V Rios Signatu Date 6/6/17