HomeMy WebLinkAbout1751 S College Ave - Applications/Demolition - 04/18/2013Planning, Development & Transportation
City Of 281 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 # 5001771 Date V-M-/3
For office use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
il r/ 5. C e 1
/1le- $ 7 s C;0 C__a c7
Property Owner Name Address
City/State Zip
Phone
/�,�► f- G ♦ q,�t
Applicant Name Address
City/State Zip
Phone
w% /fe IA00 `14'e st .+ ✓'
Contractoy Lic # Address City/State Zip
p~et �.,f.F�4rKcN.gd� Jd;
Phone
9 S 8 ?ev
-172
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? 4'Ftere
❑ Report
Sales tax number is required by allcontraclors
Are you paying with your trust account? ❑ Yes
5�-No
Is this a residential or commercial project? ❑ Residential ❑ 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 ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes §Alo - If yes, you may need to c ntact Historic Preservation
If this is for a demolition permit, what year was the building constructed? Z& )r- 7 b f
If pf ior to 1975, you w/ll need an asbestos assessment to submit with this application.
Description of work V C_^ o I` S m ;11,- CO- P 11- 4 7`f ' )Ilk r L i" /` � C_-
*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.
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Applicant: vv` r `� �t o-
Print Name: Signatu�/ � Date .