HomeMy WebLinkAbout2649 Avocet Rd - Applications/Other - 10/04/2018a/3(--)
City 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
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 X Wood/ReNM Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # z ( 8 b Date
For o ice use only
Job Site Address (required) Value of Construction,(Jabor, materials, profit)
Property Owner Name Address City/State Zip Phone 970
Jahn 2LoAarl a6zt9Av-oc-et h'c% %o� //�✓ts' C'!� �D�a (,�3i-�.77.
Applicant Name Address City/State - ,Zip Phone %7.6)
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Ccintractor, Address City/State Zip Phone (97c�)
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Jere ❑ Report
Sales tax nu eris�cWire�d�iyallcontractors Are you paying with your trust accounts ❑ Yes XNO
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? ❑ YesANo If yes, you mayneed to contactHistoncPreservation
If this is for a demolition permit, what year was the building constructed?
Description of work 7J15�d
Sfy�e_ Qi1rl l ass ZI e,�Aim4e.V
*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 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 haspaid and issued.
been
Applicant: � /,n/ ,U ��
Print Name, 1 Signature Date `T
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Revision date 2162017