HomeMy WebLinkAbout1314 N College Ave - Applications/Sprinkler - 04/14/201404/09/2014 WED 10: 17 FAX Iinds
14001/002
City of Planning, Development & Transportation
281 K College Ave P.O. Box 580
F®rt C611i s 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 # 3/ Ll 0/ -1,6b
For office use only
Incomplete applications will not be accepted.
Date `Y// Y.// C(
Job Site Address (raqulred) Value of Construction (labor, materials, profit)
$ l000co
Property Owner Name
(, D P PWGI 131
Address
, C62
City/State
. � A1t� t Col
Zip
'1 (bno
Phone
� - '1�I D�
Applicant Name
Address
City/State
Zip
Phone
I'1 S Vl t I
I(AA MlP aw
l (0 Z
2
Contractor LI #
A dress
City/State
Zip
. Phone
2
��.W1
Ut GINS c
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
}lere ❑ Report
sales tax number Ismquiredbyall contractom
I 31 �
Are you paying with your trust account?
dYes ❑ No
__Is this.a_restdental..or_commercial_project? .....❑..Residential. .N.-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 R Other (explain) - L� l W
Is this building SO years of age or more? ❑ Yes ❑ No I 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 th/s application.
of work
Aai r,�(:
0-, r
11 lawn sNnnKiertudcKnow 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.
Applicant: Sin `1lim n
Print Name; 1� 11 I' Signature
Date