HomeMy WebLinkAbout224 N Grant Ave - Applications/Deck - 03/08/2016City 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
❑ 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
'on1 the application. Incomplete applications will not be accepted.
Ate # � �Q l Q `� Date
For ofce use only v ^ j ,i puq;h a V1y !
lob Site Address (required) Val ucj of Construction (labor, materials, profit)
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Prope Owner namp
Address J/State Zi
Pone
Applicant•Nam n P
Address Ity/State�� �Zipjh
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Contractor
Address City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? lij Here ❑ Report
sales tax number is required by all contractors Are you paying with your trust account? /❑ Yes ❑ No
Is this a residential or commercial project? U4tesidential ❑ Commercial
If residential, is it: ❑ Single Family Detachk ❑ 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 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?
Ifpnor 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 Plumber Mecha
I hereby acknowledge that I have read this application and state that tq above inforn
comply with all requirements contained herein and city ordinances and(9ttate I ws regu
((�� J permit is not valid until it has been paid and issued. A
Applicant: II,l J/ J ��' "
Print Name: 6/// Signature
Roofer
Other
complete and correct. I agree to
uldinq construction. I know that a
Date
ri