HomeMy WebLinkAbout619 AGAPE WAY - APPLICATIONS - 5/27/2008G
City of fort Collins Building and Zoning Dept. P.O. Box 580 Fort Collins, CO 80522
Phone 970-221-6760 Fax 970-224-6134
City of Fort Collins OVER-THE-COUNTER PERMITS ONLY
Use this application to apply for a permit for any of the following: (check all that apply) ❑ air conditioning, ❑ demolition
(interior non-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.
Application #
ate Z m 4 Y OG
(for office unse onlly)
Property Owner Name Address Phone
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Applicant Name Address z i p Phone
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Contractor Name City Uc: # Address Phone
Contractor City of Ft. Collins sales tax # Pay taxes here? ❑ Yes ❑ No
Job Site Address
Value of Construction (labor, material, profit)
%l A6%APiE I,vAY
$ .
Is this a residential project? 1( Yes ❑ No
If residential is it: ❑ Single family detached ❑ Condo/Townhome (single family attached)) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
Is this a commercial project? ❑ Yes O 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? ❑ Yes ❑ No��
If yes, you may need to get historic preservation approval prior to permit issuance.
Description ofrk #O' - 1A);5
lyp
S�6rA
49 ice' e / - Y, a�
36e= Ahe al 0 1
**If lawn sprinkler/backflow preventer installation, must list licensed plumber. If first-time A/C, must list licensed a ricia .
Subcontractors: (list the contractor comp ny name or license #)
� ElectricalMechanical N/9 Plumbing /� Roofing �//% Others
I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all
requirements con ed herein nd ' ordinances and state laws regulating building construction.
Applicant: Print Name ViO
KSicmature Q 2 U C IE KN ►E L 19Fa Date ,2 r1►A I/ o
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