HomeMy WebLinkAbout1107 W Olive St - Applications/Electrical - 12/05/2019Planning, Development & Transportation
CCit�y/ Of 281 N. College Ave P.O. Box 580
�! 011t Collins 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 ❑ 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. Incomplete applications will not be accepted.
Application #
For office use only
Date I.,;i —
lob Site Address (required)
Value of Construction (labor, materials, profit)
e, olve
01
Property Owner Name Address
City/State Zip
Phone
l IV,
((6i.��/
c
I - 92993
Applicant Name Address
City/State Zip
Phone
//
9+hr� �cdled X�,ST
49- ��5i2
Flo%01O
v
Contr ctor Address
City/State Zip
Phone
ec7AI G 5 ^ r Ili
d Slelly-e co 2�9s/2
io-7oS'
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑
Here ❑ Report
Sales tax number is required by allwnbactors
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? Pl IZsidential ❑ Commercial
If residential, is it: 91-Si ge-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? es ❑ No I)
If this is for a demolition permit, what year was the building
yes, you may need to contact Historic Preservation
constructed?
work 4-4.4c'r-- -k O�ve/ w: y`�i U�y /L1�7`�r 1-!,c
*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 A 1--1/ry / 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: %/n/ _ � _
Print Name: Ir t II-C IC1 Signatu Date /�