HomeMy WebLinkAbout511 Mathews St - Applications/Electrical - 08/08/2018City 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. Incomplete applications will not be accepted.
Application # 131 q0 IP541 Date
For olf1ce use only
Job Site Address 511 Mathews Street, Value of Construction (labor, materials, profit) $1000.00
Fort Collins, CO 80524
Property Owner Name: Address: City/State: Ft. Collins, CO Zip: 80526 Phone: 970-
Steve Levinger 511 Mathews St. 430-0407
Applicant Name: Blueline Electric Address 3757 City/State: Ft. Collins, CO Zip: 80526 Phone
Dalton Drive 970-568-8239
Contractor: Same as above Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑O Here ❑ Report
Sales tax number Is required by all contractors. Are you paying with your trust account? ❑ Yes ❑x No
49288
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: x❑ 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 ❑ No Ifyes, youmayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work Electrical panel upgrade 100 Amp to 125 Amp panel
*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 ME-1187 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: Leroy V. Rios Signature Date 8/8/18
Revision date 2/62017