HomeMy WebLinkAbout425 W Mountain Ave - Applications/Addition or Alteration - 01/04/2016City Of
Flirt Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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 ❑ 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 #k� b DO d 31 Date 1 &ho
For office use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip
Phone
/
rti 1rzfb$' e_. �5�
W.iM� c �� 10_ph(
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
JLiicC#
4
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
5aiestax number isrequiredbyall contractors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? &Residential ❑ Commercial
If residential, is it: W.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 SO 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
*If lawn sprinkler/backflow prelenter, must list licensed plumber. Ififrst-time A/C, i1u f lift licensed electrician.
Subcontractors: List the company name or City of
��
f��F��tCollins license #
Electrician (1u31 \P_� Plumber �V1�1Mtw� echanical 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: f�(�� /
Print Name: 1 � &Q -ri4— a G eSignature
Date 1 /