HomeMy WebLinkAbout298 E Lincoln Ave - Applications/Electrical - 07/21/2017City of Planning, Development, & Transportation Services
Fort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 97b.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.
Application # d 1-1 � 4 a S Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit) 66 4S
Cily of Fort Collins 298 E. Lincoln Ave Fort Collins Colorado 80521 $ .00
Property Owner Name Address City/State Zip Phone
Applicant Name Address City/State Zip Phone
Wieffifield Group Contracting 1270 AUtomatbon Drive- SUOte #500 Windsor Colorarin 8171550
Contractor Address City/State Zip Phone
Connell Resources 7785 Highland Weadows PKY. #100 Fort Coll Ons. Colorado 80550
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
sales tax number isrequired byall 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 contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
D�epcd tion of work Electrical Food Truck Pedestals new Installation
*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 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: ��NI t-c Co n VOLq -` -7 z tZ7-
Print Name: Signature Date
>_50
Revision date 21E2017