HomeMy WebLinkAbout217 2nd St - Applications/Addition or Alteration - 05/11/2015Planning, Development & Transportation
City of 281 N. College Ave P.O. Box 580
Piet CoM ns 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 9i 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 # TI � O?2( 05711. Date S11t 1(s
For office use only
Sob Site Address (required)
!Value of Construction (labor, materials, profit)
37
Property Owner Name Address
City/State Zip Phone
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Applicant Name Address
City/State Zip Phone
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Contractor Address
City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here Report
sales taxn mberisrequiredbyal/contractors
Are you paying with your trust account? ❑ Yes (9 No
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v
Is this a residential or commercial project? W Residential ❑ Commercial
If residential, is it: ® Single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ICI No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975 you will need an asbestos assessment to submit with this application.
of work f�P_Mc
M0IJ4L 4-0
*If lawn sprinkleribackfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: ListthemmpanynameorGtyofHCollins license #
Electrician Plumber thl? O .7 Mechanical Roofer Other
I hereby acknowledge that I have read this application and slate 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.
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Applicant:
PrintName: \Al\ al�na Sigma re Date 5/ //d