HomeMy WebLinkAbout312 E Myrtle St - Applications/Addition or Alteration - 05/30/2013Cit%l of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort 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.
Application # �150as60
For olirce use only
Incomplete applications will not be accepted.
Date 1" 1,&r 310 1 Z-v 13
Job Site Address (required) Value of Construction (labor, materials, profit)
3�2 E-. "f ff'kt <- Pr y $ 3�l
Property Ow er Name
icii I r�tJ BA►JDco M.A
Address Cit/State
312 E . tH'fPEd �3160
S Zip Phone
- �o
Applicant Name Address City/State
Jo.y r>vmo� � 3'2 c, coAF_ f6 w, c . F L
Zip
S°�zl
Phone
22%_ .69 2
Contractor Lic #
Jb.i✓,-�1z�rISF,�, p9-►9
Address City/State
3�5 �►�Fl�w�e. cT fG
Zip
soy�1
Phone
2��- C42z
Contractor City of R. Collins Sales Tax
# Are you paying taxes here or by report?,12:Jiere ❑ Report
sales tax number is required by all contractors
Are you paying with your trust account?
❑ Yes fikNo
Is this a residential or commercial project? /4 Residential ❑ Commercial
If residential, is it:l'ffSingle 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 ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpr/or to 1975, you will need an asbestos assessment to submit with this application.
Description of word )''5QE 2.
t.il. I so' s l
b 1 Gi
*If lawn sprinkler/backflow preventer, must list licensed plumber. If fi-time A/C, must list licensed electrician.
Subcontractors: List the com n na a orjW of Ft Collins license #
Electrician*IuPlufnber . I Kpchanical 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: � � .1.�
Print Nan e�� 1 � Signature I Date 7/3 a � �