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HomeMy WebLinkAbout2301 Berkshire Dr - Applications/Electrical - 06/08/2018Fort Collins Planning, Development & Transportation 281 N College Ave P 0 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 Application #0c 1 f0A2 (4 Date For office use only Job Site Address (required) Value of Construction (labor, materials, profit) Property Owner Name Address City/State Zip Phone Applicant Name Address City/State Zip Phone r Co ak'Q r C6 3© 3a 4-7 zx> 4 Contractor Address City/State Zip Phone Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? 0,Here ❑ Report Sales tax number is required by all contractors Are you paying with your trust account? ❑ Yes _ANo Is this a residential or commercial project? A Residential ❑ Commercial If residential, is it .4 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 budding 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation If this is for a demolition permit, what year was the budding constructed? If prior to 1975, you will need an asbestos assessment to submit with this application Description of work *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 Print Name s Signature Date