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HomeMy WebLinkAbout1721 Choice Center Dr - Applications/Demolition - 06/14/2016i. r 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 ,d 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 # 1(DO 5 a - I For office use only Date • / 1 �( h �, Job Site Address (required) Va.11ue of Construction (labor, materials, profit) gyp, C �� Vt'. V/ ©�© Owner Name Address City/State Zip Phone //Property 4e (_1/6caAo&� Applicant Name Address i= .H.,5,k40ty/State Zip Phone -/6lo Contractor Address3�5 F Aa5- w}�ity/State Zip Phone U � s 1. �. 4> la I �o fy� Cbl�; CO ZS `� - Yf - l 610 Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Here ❑ Report required Sales tax number is by all contractors Are you paying with your trust account? ❑ Yes g_No Is this a residential or commercial project? ❑ Residential 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 ❑ Other (explain) Is this building 50 years of age or more? ❑ Yes KNo 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-T-y�ktjr et oAz� mt&-!5� acmc u.�'GG�v�-F-ic a\ *If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician. Subcontractor1s:_ List the company name or City of Ft Collins license # r Electrician s , YC Plumber ✓"Cc\�`� Mechanical C-1as iACO\ Roofer Other r 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: Print Name: Scc>4 - W - r &WnScktaonctc-CSignature Date 4/T/1llp