HomeMy WebLinkAbout119 Peterson St - Applications/Addition or Alteration - 09/30/2008City of fort Collins Budding and Zoning Dept P O Box 580 Fort Collins, CO 80522
Phone 970-221-6760 Fax 970-224-6134
OVER-THE-COUNTER PERMITS ONLY
City of fort Collins
Use this application to apply for a permit for any of the following (check all that apply) ❑ air conditioning, ❑ demolition
(interior non structural), ❑ electrical alteration (not service change), ❑ gas lighter, ❑ gas line, ❑ gas log, ❑ heating unit,
❑ lawn sprinkler, ❑ mobile home replacement, ❑ roofing, ❑ sewer 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 #
(for office unse onily) Q
Property Owner Name Address X)P Phone
01 LIMP I/I EWIIA u9, Z 2- 72o Z — ? I7 - 3 %'//
Applicant Name Address z i P Phone
Contractor Name City Lic # Address Phone
�2-5'AFC `Lr �' 9?
jzWnes lbmg- /.y/�RsU Vs
Contractor City of Ft Collins sales tax # Pay taxes here? XYes ❑ No
Job Site Address J G S �
Value of Construction (labor, material, profit)
-
$ a
Is this a residential project? Yes ❑ No
If residential is it W Single family detached ❑ Condo/Townhome (single family attached)) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
Is this a commercial project? ❑ Yes 'gNo
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? P� Yes ❑ No
If yes, you may need to get historic preservation approval prior to permit issuance
Description of Work S'r,4-GL G-6A&5S C*5rg ?&rx-�7- .► L./62L
Z 9 x S u yu r 7NG
**If lawn spnnkler/badkfiow 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 regulatingZbuildin construction9 7Print Name i i""� Signature ,�� Date / '>O—