HomeMy WebLinkAbout807 Marble Dr - Applications/Electrical - 02/25/2020Planning, 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 apply for the following permits only (check all that apply).
❑ Air Conditioning XElectrical 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 # 5 Z vy 16 o `� Date zi�S `�Z�
For office use only � TjC1 rr _ '1f- 41A 2
Job Site Address (required)
Value of Construction (labor, materials, profit)
vlui a T07
I'lak
tx, Puih WEAS Cv
4/2O-IQ
Property Owner Name
Address
City/State Zip
Phone
JR
Applicant Name
Address
►
City/State Zip
PI. rt I MOOo3St
Phone
L A� >(E' �(,
�D - d v
Contractor
Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
WReport
Sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? )9 Residential ❑ Commercial
If residential, is it: ,d 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 K No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
• • • • liL$FrIi �vJ�il�eilJ,1't�il��l�i'��•l ��
i
*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 M E - 1011 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: c7.,;47ri t�fiYyt,Signature
Date ba Z