HomeMy WebLinkAbout1300 Redwood St - Applications/Other - 09/18/201912g�3
Fort Collins
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 ❑ Electrical Alteration ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawprinkler
ElMobile Home replacement ❑ Sewer Line ❑ Ventilation ❑ Water Heater ❑ Water Line Wood/Pellet Stove
(mu f be EPA certified, provide make, model and manufacturer).
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Comp ete a I applicable information on the pplication. Incomplete applications will not be accepted.
Application # St
9 1( Q 0a
For office use only
Date SPP ab 19
Ti'-on
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
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City/State `77J-2sZip
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Phone
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Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
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
ON o
Is this a residential or co mercial project? 4 Residential ❑ Commercial
If residential, is it: K 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? ❑ Yes g6 If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
of work
*If lawn sprinkler/backnow 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: � �
Print Nam y Signature Dat
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