HomeMy WebLinkAbout2536 W Stuart St - Applications/Electrical - 01/03/2018Eggers Electric Inc
970-669-0476 p.2
Planning, Development & Transportation
City Of 281 N. College Ave P.O. Box 580
Fort Collins Fort Collins, CO 80524
`- Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to appWor the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) 15 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 th application.
Application #
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Incomplete applications will not be accepted.
Date 1 L,-? 1z�
Job Site Address (required)
Value of Construction 0abor, materials, profit)
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Property Owner Name
Address
City/State Zip
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Phone Tau- .
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Applicant Name
Address
City/State Zip
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Con ctor
Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
Are you paying with your trust account?
❑ Here ❑ Z port
❑ Yes 90
Sales tar number is required by aU contractors.
Is this a residential or commercial project? E5`izesiciential ❑ Commercial
If residential, is it: T'Singie 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 so years of age or more? ❑ Yes o If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of
*If lawn sprinkler/ba6flow 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 ff
Electriciarill- i^i d Plumber. Mechanical Roofer
Other
I hereby acknowledge that I have read this application and state that the above information is complete and conect. 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:-
11311 2
Date �