HomeMy WebLinkAbout5219 Abbey Rd - Applications/Owner Authorization - 07/03/2018Fort Collins
Planning, Development & Transportation
281 N College Ave P O Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
DEMOLITION PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply)
• Demoldion-intenor non-structural
0 Partial Demolition of existing budding
O Demolition of entire building or residence
Complete all applicable information on the application Incomplete applications will not be accepted
Application # b 126 Date I
For oflrce use only
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip Phone
1 le _ - - o Y26 o f
Applkant Name Address City/State Zip Phone
47
Contra Address City/State Zip Phone
Contractor City of Ft Collins Sales Tax #
Sales tax number /s re*red by alp co no-actas Are you paying with your trust account? ❑ Yes ZRW-
Is this a residential or commercial project? Idential O Commercial
Is the demolition of an upcoming Dtve%mentlitey1ewproject? D Yes G-No
If residential, is It: CYMngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
0 Multifamily (apartment) ❑ Garage Square footage It detached
Number of dwelling units to be demolished,
If commercial, is it O Bank 0 Bar O Church D Hotel/Motel O Medical office D office O Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? 0 Yes 0 No
Type of New Building Planned. 134-iingle Family Detached 0 Condo/townhome (single family attached)
0 Multifamily (apartment) 0 Duplex 0 Detached Garage CI Commercial Mixed -Use Building
Descripbon of work
Square footage to be demolished:
Subcontractors: List tfre company na r Oty of Ft Collins /kense 0
Electrldan C � _ Ph,rt�er 7 -1 Mechanical LA&E Roofer O 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
'///2fr7/ Signature
Date vG a ���
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