HomeMy WebLinkAbout614 E VINE DR - APPLICATIONS - 4/28/2016City of
�� kCollin
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) 8 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 # a) U 0 a a 5 o Date 4/28/2016
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
614 E. Vine Drive
$5,000.00
Property Owner Name Address
City/State
Zip
Phone
Larimer County 614 E. Vine Drive
Ft.Collins, CO
80524
Applicant Name Address
City/State
Zip
Phone
Dave Ruegsegger 2643 Midpoint Dr. Unit F
Ft.Collins, CO
80525
970-219-4012
Contractor Address
City/State
Zip
Phone
Merit Electric Inc. 2643 Midpoint Dr. Unit F
Ft.Collins, CO
80525
970-266-8100
Contractor City of Ft. Collins Sales Tax # Are you
paying taxes here or by report?.
❑ Here 8 Report
5ales tax
#19171 berisrequiredbyallcontractors. Are you paying with your trust account?
❑ Yes INNo
Is this a residential or commercial project? ❑ Residential 8 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 8 Other (explain) Mobile office service
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?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work Install a 100 amp, 120/240 volt service from an existing panel to a new mobile office unit.
*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: Dave Ruegsegger
Print Name: Signature
Date 4/28/2016