HomeMy WebLinkAbout418 Edwards St - Applications/Demolition - 10/26/2011City Of Planning, Development & Transportation
Fort Collins Fort N. College Ave P.O. Box 580
Collins, CO 80524
Phone 970-41616-2740 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
)M 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 # 6/1011c51 Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
/SS L_)-„1q2DS .S'7-Foiz�f (_0 $.2%, o0
Property Owner Name Address
City/State Zip
Phone
U%FJKayasery
S1 I SAT 601.410Z 915�
Y S/
Applicant Name Address
City/State Zip
Phone
S'R A
Contractor Lic # Address
City/State Zip
Phone
N /-
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number isrequiredbyall contractors.
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? 1,'A Residential ❑ Commercial
If residential, is it: 4 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? >SI Yes ❑ No If yes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? i 9.?S A-7197AJ h4ATy �1yDi'ltcw "
if prior to 1975, you will need an asbestos assessment to submit with this application. T `h 43P Rr7cELI
Description of work RE&,:vn3 1---njec_s,?0 -P6gcr e.0 `17AP 13-le1- n = Me- Sr*?LGrG7«21
*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 01_ac iatc 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: 7R �c A �/�oGS��u Signature 49 �G �_, a*, Date Oc-