HomeMy WebLinkAbout1313 Green St - Applications/Other - 01/31/2013City of
Fort Collins
OVER-THE-COUNTER PERMITS ONLY
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
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 #
For office use only
Date
Job Site Address (required)
Value of Construction (labor, materials, profit)
Q L rA awl DDM1l4Er 0e"1 1313
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.20S4T8 1 aSl
Property Owner Name Address
City/State Zip
s Phone 1350
Applicant Name Address
City/State Zip
Phone
Contr//actoo SWe-eP Address
City/State Zip
Phone
41/Gt ed 0.30
337997 6re ele60 33
701339- 30
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
JK Here ❑ Report
Sales tax number is iredbyal/mntractors
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Are you paying with your trust account?
❑ Yes )8(No
,Y SO
Is this a residential or commercial project? - INResidential ❑ Commercial
If residential, is it: XSingle Family Detached
❑ Multifamily (apartment)
If commercial, is it: ❑ Bank ❑ Bar ❑ Church
❑ Restaurant
❑ Condo/townhome (single family attached) ❑ Duplex
❑ Garage
❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Other (explain)
Is this building 50 years of age or more? Yes ❑ No If yes, you may need to contact Histor/cPreservation
If this is for a demolition permit, what year was the building constructed?
If pnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work Tn%+v,11AJfer% : Weed sbvt+
*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:
Print Name: >�M1MW o��� Signa Date