Loading...
HomeMy WebLinkAbout215 Mathews St - Applications/Sprinkler - 03/06/2017City 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 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 ❑ 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 #& / r70-1 O 7 9 Date U 3 • ©C9 ' ZO l For office use only Job Site Address (required) Value of Construction (labor, materials, profit) 215 Ida eius S I °v `'wob Property Owner Name Address City/State Zip Phone Applicant Name Address City/State Zip Phone rv-, o- . z r006) 80504 q70q* Contractor Address City/State Zip Phone n rf . 0 (16-5 a z6� Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report sales iaxnumber isrequired byall contractors. Are you paying with your trust account? ❑ Yes ❑ No . Is this a residential or commercial project? ❑ Residential ACommercial If residential, is it: ❑ Single Family Detached ❑ Cond townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office IXOffice ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building 50 years of age or more? ❑ YesANo If yes, you may need to contact Historic Preservation If this is for a demolition permit, what year was he building constructed? Description of work *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 Rt rlU6iQ 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 Name: 1\�the bJ40/1 Signature �—J CVO,f U;K Date 03 , Uo • I Revision date 202017