HomeMy WebLinkAbout120 Bockman Dr - Applications/Demolition - 07/14/2014Cit Of Planning, Development & Transportation
y} 281 N. College Ave P.O. Box 580
�` Collins 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
K 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 # b ?2 a
For office use only
Date 7/14/14
Job Site Address (required)
Value of Construction (labor, materials, profit)
120 BOCKMAN DRIVE, FT. COLLINS, CO 80525 $ 41, 000.00
Property Owner Name Address
City/State Zip Phone
Imago Enterprises 200 Mason St.
Fort Collins CO 80524 970.222.7528
Applicant Name Address
City/State Zip Phone
GOLDEN TRIANGLE CONSTRUCTION 700 WEAVER
PARK ROAD LONGMONT, CO 80501 719-314-0531
Contractor Address
City/State Zip Phone
GOLDEN TRIANGLE CONSTRUCTION 700 WEAVER PARK ROAD LONGMONT, CO 80501 719-314-0531
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? N Here ❑ Report
Sales tax number is required by all contractors.
We -oU,payingwlth"yourtrU9taccouflt� ❑Yes NO�.
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Is this a residential or commercial project? ❑ Residential K 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 M Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes K No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? 1991
If prior to 1975, you will need an asbestos assessment to submit with this application.
Des tion of work M�C.�TI�U a� �1.1i�R10(K WALLS A+vn cQL1N&S'_
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*If lawn sprinkler/backfiow 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 b n paid and issued.
Applicant: y/'
Print Name: Signatur )A\i i A 'l ICII Date