HomeMy WebLinkAbout2203 S Shields St - Applications/Demolition - 10/25/2012City f Planning, Development & Transportation
FliC y O281 N. College Ave P.O. Box 580
rt Collins 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) ❑ 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 # E) e `-K J 1 \p
For office use only
Date
lob Site Address (required)
Value of Construction (labor, materials, pro it)
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33. SHIELDS
sr. fi b,
Property Owner Name
Address
City/State Zip Phone
hc
Aant Name
5AUL
Address
City/State Zip Phone
E"p-L-kc-l-1,
Contractor
Address
City/State Zip Phone
'H EAF, %A 1!_6At5TflJLT10AI
/q1 F,41QQFi.
WwiJs & ;5bS2-2 21. ZSS
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
sales tax number is required byall contractors.
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential X 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 tPtOther(explain) 2r-FRO0r✓1
Is this building 50 years of age or more? ❑ Yes jiLlNo If yes, you may need to contact Historic Preservation
If this is fora 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
—
*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 #
ElectdcianFi..� Uect 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:
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Date 10 'Z / -1 y