HomeMy WebLinkAbout401 Linden St - Applications/Electrical - 10/04/2018City of Planning, Development, & Transportation Services
Fort Collins 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) X 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 informatio o ,the application.
Application # l\
For office use only
Incomplete applications will not be accepted.
Date
10-4-18
Job Site Address (required) Value of Construction I bor, materials, profit)
401 Linden St
Property Owner Name Address City/State Zip Phone
Confluence Development
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
Bret's Electric 8312 Raspberry Way, Frederick, CO 80530 720.494.8944
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here X 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 IV(Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hot Motel �, N)edicaf officgg � Office ❑ Retail
❑ Restaurant ROther (explain) IXe se 1u, amily
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work Temporary Electrical Meter Panel
*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 #
ElectricianBret's Electric 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: Signature Date
Revision dale 2/612017