HomeMy WebLinkAbout209 2nd St - Applications/Addition or Alteration - 05/11/2015Planning, Development & Transportation
City of 281 N. College Ave P.O. Box 580
F&t CoWns Fort Collins, CO 8OS24
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 K 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 # F-)1500 Date
For office use of
Job Site Address (required)
Value of Construction (labor, materials, profit)
3-2s
Property Owner Name
Address
City/State Zip Phone
17 cx ,
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Applicant Name
Address
City/State Zip Phone
445-00
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Contractor
Address
City/State Zip Phone
11
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Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here L� Report
RAL-stainkmberisrequiredbya0conhactors
Are you paying with your trust account? ❑Yes t�1 No
(;'Yal4`1 � 31
Is this a residential or commercial project? 0 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 30 years of age or more? ❑ Yes 12 No Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpr/or to 1975, you wi// need an asbestos assessment to submit with this application
of work Ve-0h
M o v z. 4-a
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty ofFtCollins license ff
Bectridan Plumber r'►'�P �O n 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:��r
Print Name. \Gn Signa re (Date