HomeMy WebLinkAbout724 E Myrtle St - Applications/Addition or Alteration - 01/29/2007City of fort Collins Building and Zoning Dept. P.O. Box 580 Fort Collins, CO 80522
Phone 970-221-6760 Fax 970-224-6134
j3 City of Fart Colliins
OVER-THE-COUNTER PERMITS ONLY
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Use this application to apply for a permit for any of the following: (check all that apply) ❑ air conditioning, demolition
(interior non-structural),Xelectrical alteration (not service change), ❑ gas lighter, ❑ gas line, ❑ gas log, ❑ heating unit,
❑ lawn sprinkler, ❑ mobile home replacement, ❑ roofing,Xsewer line, ❑ ventilation, ❑ water heater, water line,
❑ wood stove (*provide model name & number).
Complete all areas of the applications that are applicable to your permit request - Incomplete applications will not be
accepted. An over-the-counter permit will only be valid when it has been paid -in -full and issued.
Application # b'l �� —�
Date t ' - o
(for office unse onlly)
Property Owner Name Address z )P Phone
Applicant Name Address z i P Phone
Contractor Name City Lic # Address Phone
Contractor City of Ft. Collins sales tax # Pay taxes here? ❑ Yes ❑ No
Job Site AddressI
Value of Construction (labor, material, profit)
-�.1
Is this a residential project? Yes ❑ No
If residential is it: �K Single family detached ❑ Condo/Townhome (single family attached)) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
Is this a commercial project? ❑ Yes )(No
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
If yes, you may need to get historic preservation approval prior to permit issuance.
Description of Work t
tC& . .
"if lawn sprinkler/backflow preventer installation, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: (list the contractor company name or license #)
Electrical Mechanical Plumbing Roofing Other
I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all
requirements contained herein and city ordinances and state laws regulating ui ing on ction.
Applicant: t
Print Name NCH i-�T�� ` Signature -- T Date �g'O