HomeMy WebLinkAbout708 Oxford Ln - Applications/Electrical - 02/14/2018City of Planning, Development, & Transportation Services
Fort Collins Community Development & Neighborhood Services
`- 281 North College Avenue
Fort Collins, CO 80524 Main 970 416 2740 Fax 970 224 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 information on the application.
Application # I� V V 9 r
For office use only
Incomplete applications will not be accepted
Date Q liq
Job Site Address (required) Value of Construction (labor, materials, profit) /200.
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Property Owner Name Address City/State Zip Phone
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Applicant Name Address City/State Zip Phone
Comb It_c+ric-- sc"n-'e aS ab>ve
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? 1yiere ❑ Report
Sales tax number is required by all con&actors Are you paying with your trust account? ❑ Yes No
Is this a residential or mmercial project? esidential ' ❑ Commercial
If residential, is it•Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it ❑ Bank ❑ Bar ❑ Church ❑ Hotei/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Histonc Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work � LRep,n1rs E �P_ E ,aAc I i j; l k new 2ncf t)pqmade 14o 150a/,oS
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*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 tfiat a
permit is not valid until it has been paid and issued.
Applicant:
Print Name. C n4 ��� Signature Date a
Revision date 2/6/2017