HomeMy WebLinkAbout101 E Lincoln Ave - Applications/Electrical - 08/02/2017City of Planning, Development, & Transportation Services
Fart C011lnt Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 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) ❑ 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.
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Application # ?:) D O 4a,?)4 Date I 1 ^1
For ofte use only
Job Site Address (required) Value of Construction (labor, materials, profit)
City of Fort Collins 101 E. Lincoln Ave Fort Collins Colorado 80521 $33,000.00
Property Owner Name Address City/State Zip Phone
City of Fort Collins 4316 Laporte Ave Fort Collins- Colorado 80591
Applicant Name Address City/State Zip Phone
We0field Group Cont[actong 1270 Automation Drive. Suite #500 Windsor- Colorado 80550
Contractor I Address City/State Zip Phone
Connell Resources 85 Highland Weadows EKY. #100 Fort Collins.0
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number isrepuiredbyall contractors. Are you paying with your trust account? ❑ Yes ❑ No
08906663-0464
Is this a residential or commercial project? ❑ Residential ❑ 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) Electrical Food Truck Pedestals
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you mayneed to contactHistoric Preservation
If this is for a demolition permit, what year was the building constructed?
De ription of work Electrical Food Truck Pedestals new Installation
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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 C)ty 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. 1�\ o
Applicant: HtE( eDRDOf/!�• e-,/f .. ' L/ /t0t--j."
Print Nam Sign reDate
Revision date 2b2017 ��oi • z c/� /s,7(