HomeMy WebLinkAbout2720 Council Tree Ave - Applications/Demolition - 09/27/2016City ®f
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 a plication is to be used to a ply 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 # "; I �Ocjc)(Q q'
For office use only
Date
Sob Site Address (required)
Value of Construction (labor, materials, profit)
01ao L1
A . I
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Property Owner Name
Address
City/State Zip Phone
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Applicant Name
Address
City/State Zip Phone
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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? ❑ Here Neport
Sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes f�Vo
Is this a residential or commercial project? ❑ Residential )9 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 1Z Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes 4 No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? ,C�C���
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work LAmt � o4- vin.i s c I 4 n _17e-V_10y--r)"StY-Z �CtWk- , Cal LA
:
*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 U\�G Plumber I.(iti Mechanical I��G 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:
Print Name.Yl\1--`'11h 1(��' Signature
Date C 1 t)B I I `'
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