HomeMy WebLinkAbout107 Scott Ave - Applications/Other - 12/18/2018City 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 jK 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 # R6) I ] Date
For office use only
lob Site Address (required) Value of Construction (labor, materials, profit)
107 5cott 4ve. 22'5-00
Property Owner Name Address City/State Zip Phone
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Applicant Name Address City/State Zip Phone
►'arni� I��e1\ 182-g- 'F. Yn j COWVJ Os2 �IgJs-o2-oc>�d
Contractor Address City/State Phone 11 Q -
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'i�'e IQ.Ce bX ye.SS I $2S �- fdlL)Iberr IoV� %�IviS $OSa Sot" o
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? )'Residential ❑ Commercial
If residential, is it: XSingle Family Detached ❑ Cando/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? ❑ Yes ❑ No Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
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Description of work IV�Skt �( of- L'000 burw(N4 sl vt e GI F3
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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 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: e' Print Name Iaftl I V1 l� ie l l Signature // Date ' g
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Revision date 2/6/2017