HomeMy WebLinkAbout600 Remington St - Applications/Electrical - 08/14/2017City of
Fort 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.
Application # �l
For office use only
Incomplete applications will not be accepted
Date August 14, 2017
Job Site Address (required)
Value of Construction (labor, materials, profit)
600 Remington St
$2,500
Property Owner Name Address
City/State Zip
Phone
Hale Historic Properties LLC PO Box 614 Fort Collins, CO 80522 910
Applicant Name Address
City/State Zip
Phone -
Contractor Address
City/State Zip
Phone
Glanz Electrical Contracting, Inc. 1713 Lincoln
Ave. Al Fort Collins, CO 80524
970-482-5218
Contractor City of Ft. Collins Sales Tax # 21494
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? ® 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)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Hlstonc Preservation
If this is for a demolition permit, what year was the building constructed?
If poor to 1975, you will need an asbestos assessment to submit with this application.
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Llst 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:
Print Name: Thomas I Glanz Signatu Date August 14, 2017