HomeMy WebLinkAbout902 E Stuart St - Applications/Solar - 10/28/2015Cote of
F&t CoWns
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
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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 # , 0 7 Date 1.
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For office use only 014.000
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name
Address
City/State
Zip
Phone
Applicant Name
Address
City/State
Zip
Phone
Contractor
Address
City/State
Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by all contractors.
Are you paying with your
trust account? ❑ Yes
❑ No
Is this a residential or commercial project? iaResidential ❑ Commercial
If residential, is it: >�3tngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
i ❑ Restaurant ❑ Other (explain) —
Is this building 50 years of age or more? ❑ Yes $No 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.
Description of work
F 1. V $1--( IM C U /-r j U✓�j ,�(%,' ri a4 P V T I-y,
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Co 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 been paid and issued.
Applicant: S N UN Gi NL) 6J 0
Print Name: "'� Signature Date