HomeMy WebLinkAbout1749 Deweese St - Applications/Other - 02/11/2014Planning, Development & Transportation
FCity, 281 N. College Ave P.O. Box 580
OI t CollinsIFort 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 #_ _51 g00044 Date o2- ff-Al
For o>fIce use only
Job Site Address (required)
Value of ConstructMn (labor, materials, profit)
t 7 ag Deu�) ( -SG_
too n
Property Owner Name Address
City/State Zip
Phone
/ q
Applicant Name Address
City/State Zip
Phone
o—L—
Contractor Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? gResidential ❑ Commercial
If residential, is it: Single Family Detac ed ElCondo/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? ❑ YesANo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was a building constructed?
Ifpnor to 1975, you w/ll need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backnow 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. , A
Applicant:
Print Name: I lri'Zd ( % Signature
Date