HomeMy WebLinkAbout632 STOVER ST - APPLICATIONS - 3/25/2008City of fort -
Collins Building and Zoning Dept. P.O. Box 580 Fort Collins, CO 80522
Phone 970-221-6760 Fax 970-224-6134 d
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of Fort CoL
lin OVER-THE-COUNTER PERMITS ONLY
Use this application tD apply for a permit for any of the following: (check all that apply) ❑ air conditioning, ❑ demolition
(interior mon-structural),, ❑ electrical alteration (not service change), ❑ gas lighter, ❑ gas line, ❑ gas log, ❑ heating unit,
❑ lawn sprinkler, ❑ mobile home replacement, ❑ roofing, ❑ sewer line, ❑ ventilation, ❑ water heater, ❑ water line,
❑ wood `stove (*provide model name & number).
Complete all areas of the applications that are applicable to your permit request - Incomplete applications will not be
accepted. An over-the-counter permit will only be valid when it has been paid -in -full and issued.
I
Application # �—{R) ,[/�
D `� _ `-� )
Date J2
(for office) unse onlly)
Prclperty, Owner Name Address Phone
�e164.0 Taha table .30 C�hpee- )Q.efefflWS �s� a- i,?/
Applicant Name Address Phone
ealn�enJ �sTOryl L�onT-R.A�TIN � �� o�
Contractor Name City uc # Addr s Ph-o
Box 2)•2167 970�2-9100
Drenrien Custom Contracting D-187•0.
Ft..: Collins Co 80 2 -216
Contractor City of Ft. Collins sales tax # Pay taxes here?XI4 Yes ❑ No
lob Site Address
Value of Construction (labor, material, profit
Is this d residential project? p; Yes ❑ No
If residential is it: '% Single family detached ❑ Condo/Townhome (single family attached)) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
Is this a commercial project? ❑ Yes ❑ No
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? 12( Yes ❑ No - aw L1 19,V7
If yes, you may need to get historic preservation approval prior to permit issuance.
Description of Work e a e z i srir/ /z/z" Y s e
.**If lawn sprinkler/backflow preventer installation, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: (list the contractor company name or license #)
Electrical Mechanical Plumbing Roofing Other
I herebyladmwiedge that I have read this application and state that the above information is correct and agree to comply with all
requirements contained herein and city ordinances and state laws regulating building ing construction. o
Applicant:
Signature
Date
Print Name