HomeMy WebLinkAbout625 Peterson St - Applications/Demolition - 11/08/2016 (5)Cit
F®ryt Collins
of
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
"IRis 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 A kl f� , 6
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Date
Job Site Address (required)
Value of Construction (labor, materials, profit) Z�ovu
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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
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Contractor City of Ft. Collins Sales Tax #
Sales is by
Are you paying taxes here or by report?
Are with trust account?X❑_
Here ❑ Report
Yes No
all contractors.
tax number required s
0 01,33 63,
you paying your
Is this a residential or commercial project? 0 Residential ❑ Commercial
If residential, is it: A 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? )kYes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? / 997
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work ?GADA 'Pvo ►► C7 ' I df &071-yb QP,0 0W�
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*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 6�bv'ov Plumbef�pS Mechanical CS�'14'L Roofer b-7 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: stv I
Print Name: Uri/ �� Signat� Date