HomeMy WebLinkAbout2205 Clearview Ave - Applications/Electrical - 03/14/2017Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to applor the following permits only (check all that apply). O 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 information on thpplication. Incomplete applications will not be accepted.
Application # h 17 '0 1507 Date
For office use only
Job Site Address (required)
Value f Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip
Phone
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Eot-{'-UI s CO Bo5z5
Cho) 412---790
Ap/�li`cant Name I Q Address City/StateI nZiiip Phone
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CrI t.C�llns l V 80528
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Contractor I Address
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City/State Zip
Phone
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Contra&olir City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
Here ❑ Report
Sales tax number is required by allconbadors.
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or�co.�T mercial project? SY Residential ❑ Commercial
If residential, is it: GrSingle 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 "o 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 � yVr,CC 1 \ J�Gy+_ I P _
*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 tl w�u &,Lic. Plumber Mechanical Roofer Other
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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: �,,R
Print Name: T►V mm_ Signature Date
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