HomeMy WebLinkAbout1100 Castlerock Dr - Applications/Electrical - 09/30/2019City Of Planning, Development & Transportation
Fort Collins For N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-41616-2740 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 ® Electrical Alteration ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler
❑ Mobile Home replacement ❑ Sewer Line ❑ 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 # 8141t5eftj� myZ i5/61IVA
For office use only
Incomplete applications will not be accepted.
Date 9/24/19
93 225
Job Site Address (required)
Value of Construction (labor, materials, profit)
1100-1102 Castlerock Dr Fort Collins Co 80521 $3,575.00 `�� , (s l$QdK
Property Owner Name Address
City/State Zip Phone
John Dunn -Christina [wane
0 - C1 Jq -W
Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
Alliance Electric, Inc. PO Box 271132
Fort Collins, Co 80527 970-225-6464
Contractor City of Ft. Collins Sales Tax #
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
41064
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? 2 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 New double meter
Mike Hergenreder."N%, 1 in %_ (w P I a
Replacing Electric Panel at 1100 - No Service Upgrade had site meeting with
*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: Mike
Signature �%/ Date 9/30/2019