HomeMy WebLinkAbout718 Blue Mesa Ave - Applications/Other - 09/11/2018F®rt 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
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 t/ood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer). J
Complete all appl able nf�information on the application. Incomplete applications will not be accepted.
Application # ICovcs Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
$00.Oa
Property Owner Name
Address City/State Zip Phone
719 014- f4sLq Ian s ! ; ns OCU6526 710 -3z 41
Applicant Name
Address City/State Zip Phone
&1(O3 /V 9 7e 133I� &
Contractor
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Address City/State Zip Phone
f Gtl /0°` &V 9'70-337,&
Contractor City of Ft. Collins Sales Tax
# 0 000Z 3a'31 Are you paying taxe here or by report? ❑ Here Report
Sales tax number is required by all contractors.
Are you paying with your trust account? XYes ❑ No
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a d 1460 - r10
Is this a residential or co mercial project? R
If residential, is it: Ingle Family Detached
Multifamily (apartment)
If commercial, is it: ❑ Bank ❑ Bar ❑ Church
sidential ❑ Commercial
❑ Condo/townhome (single family attached)
❑ Duplex,
❑ Garage
❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you mayneed 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.
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name cr Cityof Ft Collins license #
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 valid until it has been paid and issued.
Applicant: 14 ckan weep LLC ry/
Print Name: cl boi- Nya a Signature
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