HomeMy WebLinkAbout3407 Stover St - Applications/Electrical - 08/14/2018City 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 ap I for the following permits only (check all that apply). ❑ Air Conditioning
El 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 # 66611-z-, Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
�401 Slao� G 11 ►000,00
Property Owner Name Address City/State Zip Phone
cl, t 970SG7(58
Applicant Name Address City/State Zip Phone
c._m-6
Contractor Address City/State Zip Phone
Nf' o .E(e-C+-1C- 1?Z 2-0 �r� k],n A PC Co 8057- { 970s'9ILtoS7
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ^KHere ❑ Report
Sales tax number is required by all contractors Are you paying with your trust account? ❑ Yes No
Is this a residential or commercial project? �Kesi ntial ❑ 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 ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work R�914ro _ P.Ne,l Li )A ^CA,7 . "o r,pa rkJ-0--
*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 that a
permit is not valid until it has been paid and issued.
Applicant: p
Print Name: l ,A�� b Signature Date 8 /� b
Revision date 21M017