HomeMy WebLinkAbout4040 S College Ave - Applications/Electrical - 05/03/2018City of Planning, Development, & Transportation Services
Flirt 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) gElectrical 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.
Application # $(005458
For office use only
Date April 10, 2018 5l 3 I lfi
0 4 #'15
Job Site Address (required) Value of Construction (labor, materials, profit)
4040 South College Avenue $4,000.00
Property Owner Name Address City/State Zip Phone
Best Buy 4040 South College Ave. Ft. Collins, CO 80525
Applicant Name Address City/State Zip Phone
All Reach Lighting & Electrical Contracting 7230 W. 118th Place, Unit C, Broomfield, CO 80020 303-432-1041
Contractor Address City/State Zip Phone
Same
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here 12 Report
sales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes ® No
Application #0002021724
Is this a residential or commercial project? ❑ Residential O Commercial
If residential, Is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office lid Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes Q No Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work Install power for new bailer equipment O -5F vlca
O
*If lawn sp nkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name orCYtyofFtColllnsUcense#
Electrician PI -/4Oc' 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: Paul M. Knapp Signature�l —C' 'v` Date April 10, 2018
Revlslon date W2017
5k61 A.