HomeMy WebLinkAbout1327 SAINT JOHN PL - APPLICATIONS - 7/20/2012of
Fort Collins
Planning,; Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins; CO 80524
Phone 970-416-2740 Fax.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 # 60-0 Date 7 a0
For o>iice use only
Job Site Address (required) Value of Construction (labor, materials, profit)
t ae $
Property Owner Name
ffj, - r' r✓
Address
5r o
City/State
PAC- (,H
Zip
Co
- Phone
2 -.1-e
ApplicanYName
Address
City/State
v Cu
Zip
D 38
Phone
Contractor Lic #
JtC� ' 0-31"
Address
n,3
City/State
4,60ri{ N44 Ca
Zip
o4/3
Phone
-y90
Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by all contractors.
Are you paying taxes here or by report? /KHere ❑ Report
Are you paying with your trust account? ❑ Yes KNo
Is this a residential or commercial project? ❑
If residential, is it: JK Single Family Detached
Residential ❑ Commercial
❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
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 j$ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit'with this application.
Description of work rod ►xi 1 rt be"&.+-.Le,Kt
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Listthecompany name or City of Ft Collins license # ,{
Electricia Z0 d4 +- I� Plumber —� Mechanical O�i',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: �a)ts�[.�-i Signature Date