HomeMy WebLinkAbout648 S COLLEGE AVE - APPLICATIONS - 5/4/2006City of fort Collins Building and Zoning Dept. P.O. Box 580 Fort Collins, CO 1 80522
Phone 970-221-6760 Fax 970-224-6134
OVERoTHEmCOUNTER PERMITS ONLY
City of Fort Collins
Use this application to appy for a permit for any of the following: (check all that apply) ❑ air conditioningdemolition
(interior non-structural electrical alteration (not service change), ❑ gas lighterAas 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 # �
Date
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for office unse onlly)
Property Owner Name Address LAP Phone 9Z
L,S r Ind Gi% ddV
Applicant Name Address z i P Phone
Con or Name City Uc # Address Phone
Al h)S %
Contractor City of Ft. Collins sales tax # Pay taxes here? '15-Yes ❑ No
Job Site Address
Value of Construction (labor, material, profit)
&2 ���
$ 5
Is this a residential project? ❑ Yes o
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 ❑ Officelietail
;restaurant 0 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 of Work i i 6- 4l-A
"If lawn sprinkler/backfiow preventer installation, must list licensed plumber. If first-time A/C, must fist licensed electrician.
Subcontractors: (list the contractor company name or license #)
Electrical Mechanical' "-- Plumbingf�fb0PT-- Roofing - - Other
I hereby acknowledge 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 construction.
Applicant: �—
Print Name �� Signature Date rJ