HomeMy WebLinkAbout1318 Coulter St - Applications/Addition or Alteration - 04/30/2014Fort 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) ❑ 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 #
For office use only
Date Lj_30-1G1
Job Site Address (required)
Value of C
struction (labor, materials, profit)
co� t/
o
Property Owner Name
Address
City/State
Zip
Phone
04 F_; S CV) of
Applicant Name
Address
City/State
Zip
Phone
l 41
Contractor
Address
City/State
Zip
Phone
l3oo
, . 0.
Co, gosvv
q/z 349t
Contractor City of Ft. Collins Sales Tax #
sales tax number is required byall contractors.
Are you paying with your trust account? ❑ Yes
,�No
Is this a residential or commercial project? f 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)
Is this building 50 years of age or more? ❑ Yes kNo 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.
Descri tign of work c %. n y, rcc-SS,6/
*If lawn ssprinkler/backflow pre4enter, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
ElectricianAC 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: — rr
Print Name: J J `nl .. ./(0�1 Signature
Date Il-.�9-)�l