HomeMy WebLinkAbout2302 Nancy Gray Ave - Applications/Electrical - 12/03/2018�(� Of Planning, Development & Transportation
Y 281 N. College Ave P.O. Box 580
6rCollins Fort Collins,
CO 80524
Phone 970-41616-27402740 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 inf
ormation on the application.
Application # 1 Vy"
For office use only
Incomplete applications will not be accepted.
Date December 3, 2018
Job Site Address (required)
Value of Construction (labor, materials, profit)
2302 Nancy Gray Avenue
$2 700.00
Property Owner Name Address
City/State Zip
Phone
Scott Bores 2302 Nancy Gray Ave.
Fort Collins, CO 80525
720-438-9715
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 M 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 Ifyes, you mayneed to contact HistoricPreseruation
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.
*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:
Print Name: Thomas J Glanz -Signature LC E l lu,�[/9i Date December 3. 2018
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