HomeMy WebLinkAbout3830 Manhattan Ave - Applications/Addition or Alteration - 05/22/2017City of Planning, Development, & Transportation Services
Fort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins. CO 80524 Main 970 416 2740 Fax 970 224 6134
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OVER-THE-COUNTER PERMITS ONLY 4110 -1?
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/Pallet Stove (must be EPA certified, provide make, model and
manufacturer)
Complete all applicable information on the application. Incomplete applications will not be accepted
Application # (70 :2 i0 - Date `� S eRs • / 7
For office use only
Job Site Address (requ/red) Value of Construction (labor, materials, profit)
3 E VT sxS
Property Owner Name Address City/State Zip Phone
Applicant Name Address City/StateZip Phone
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tractor Address City/State Zip Phone
i9QS10AA3W-POROK I LaUMWf 60 FD -573-3144
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number isrequIredbyall amtradws Are you paying with your bust acoount7 ❑ Yes ❑ No
Is this a residenbal or commercial prolect7 ❑ 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 SD years of age or morel ❑ Yes ❑ No If yes, you may need to contact Hcslonc Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work SITE L 6i+rW(o
*If lawn spnnkler/bacldiow preventer, must list licensed plumber If first-time A/C, must list licensed electrician.
Subcontractors: [rst Me company name or Gty of R Collins lrcense 0
Electrician Plumber Mechanical 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 until it has been paid and issued.
Applicant:
Print Name Signatu Date
Revision data 2AM17 1 l J / (mil