HomeMy WebLinkAbout224 Linden St - Applications/Addition or Alteration - 03/17/2014Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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) A Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilations 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 # &I � 0 I ��� Date 3 -/7- %y
For o!i'ice use only
Job Site Address/(required)
Value of Construction (labor, materials, profit)
m-o
rty Owner Name Address
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City/State Zip Phone
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Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
Contractor City of FL Collins Sales Tax #
Are you paying taxes here or by report? @9Here ❑ Report
Saks tax number is required by all contractors.
Are you paying with your trust account? ❑ Yes R) No
Is this a residential or commercial project? ❑ Residential )9Commercial
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 MoMer (explain) g>scJ AA&
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?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-tim , mu icensevelectrician.
Subcontractors: List the company name or City of R Collins license # %1 .
�e7r1c - (�
Electrician_S;VSyz'..+f Plumber V/��"7Mechanical 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: ,y2��j
Print Name:, �i llleylP Signature Date 3 /7-