HomeMy WebLinkAbout428 Linden St - Applications/Demolition - 02/05/2016City of
Fort 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
0 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 #131 A 0 5
For o>tice use only
Date �• S , 16
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip
Phone
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Applicant Named Address
City/State
Phone
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Contractor Address
City/State Zip
Phone
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Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here YAeport
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 1110'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 M'Other (explai A- I
Is this building 50 years of age or more? ❑ Yes Q No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? iz
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*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 #
Electrician E<dr%�'r Plumber'?/PTA /77E�'Mechanical �i�� ��"''�Roofer �/4 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: A
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Print Name: Zvi i°' ` C �"i"�� Signature Date •2 100'4