HomeMy WebLinkAbout1415 Blue Spruce Dr - Applications/Demolition - 09/08/2014City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
C
_F6rt 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
UDemolition (interior non-structural) UElectrical 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 # 12�1 40 e®zc) Date September 8, 2014
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
1415 Blue Spruce Drive Fort Collins
CO 80524 $5,600.00
Property Owner Name Address
City/State Zip Phone
CPP Inc. dba Cermak Peterka Petersen
Inc. Fort Collins CO 80524 970-498-2322
Applicant Name Address
City/State Zip Phone
Delehoy Construction Inc. 3109 S. Taft Hill Rd. Fort Collins CO 80526 970-226-0836
Contractor Address
City/State Zip Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? M Here ❑ Report
sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential IlCommercial
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 %XOther (explain) Testing Lab
Is this building 50 years of age or more? ❑ Yes X%No Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? 1977
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work demolition of wind tunnel and staging platform.
*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 # Solidstart
gfilthan Solutions a
Electrician c ric Plumber N/A Mechanical N/A Roofer N/A OtherRMS Rigging
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: C.7R.4A,-r FtcroTr Signature Date