HomeMy WebLinkAbout1205 W Elizabeth St - Applications/Demolition - 03/29/2011Fort 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
T is 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 Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
I205- k%). E1_1ZABETH
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W/3 387.00
Property Owner Name
Address
City/State Zip Phone
NICo` 44MPUS A)F—ST
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77,8 FT &t4-iAvs Co 8652Z 97o—Z� /p3
Applicant Name
Address
City/State Zip Phone
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Contractor //►►
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Address
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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 XNo
94- roo3z9s
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) RESTAV,9AA 7' 9E7A MC
Is this building 50 years of age or more? ❑ Yes XNo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? APPR+oX. Zoo Ss
If pnor to 1975, you will need an asbestos assessment to submit with this application.
ption of work liEMo 1�tll�CT ICAL XArD P4U&781A14 FR? M k1T_e IE,.1
*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 _ PlumberLheCN. ASTEK5Mechanical 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: GQA#d r Signature G%� Date y9 /
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