HomeMy WebLinkAbout2727 Arancia Dr - Applications/Electrical - 03/22/2018Fort Collins
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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 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. Incomplete applications will not be accepted.
IYApplication # %Date 3�<
For An; use only
Job Site Address (required)
Value of Construction (labor, materials, profit /-w!
Property lOwner Name
Address
City/State Zip Phone
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Applicant Name
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Address
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City/State Zip Phone
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Contractor %
l Add�reLss,�,,
City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? 4f Here ❑ Report
Sales tax number15 ��redbyall contractors
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Are you paying with your trust account? ❑ Yes dp No
Is this a residential or ommercial project? 4 Residential ❑ Commercial
If residential, is it: A 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 0 No If yes, you may need to contact Histonc Preservation
If this is for a demolition permit, what year was the building constructed?
Descriptiq of work Ir/,C I i�A'�
*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 budding construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: I
Print Name: ��1�� r� Signature Date