HomeMy WebLinkAbout1809 S TIMBERLINE RD - APPLICATIONS - 6/15/2012City of
F`rt Collins
OVER-THE-COUNTER PERMITS ONLY
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
y Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
•IN 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 iinf-oorm�tion on the application.
! Application # V7� _ `e�??
For office use only
Incomplete applications will not be accepted.
Date , ),,Az 0, U i 2-
Job Site Address (required) --po Value of Construction (labor, materials, profit)
%90qb—
Property Owner Name
Address
City/Spate Zip
Phone
I
C /±o-f (-or�4 CwJ nS L t l
CS 70G 1nJocc.� 51, o e 1 (�o Cc' 8'0-5-2,2-
Z Z ( 67 o G
Applicant Name
Address
City/State Zip
Phone
%r&Y/5 IV4 Ike r
Contractor rr Lic # G (. 3
Ulm' "ri s Jeri
Address
30 o Lo
City/State Zip Phone
ache C & Soo- ola J -bb ll
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
sales tax number is required by all contractors.
61 fy-
Are you paying with your trust account? ❑ Yes ® No
hAR6E#.-O)jy000000. 5-gqV,/yoo abo0. C .
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ 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 0 No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? I ci 80'5
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work p2Ma/rs6 old tt,n ra f•ui1e�/office sfi�ra a7>T
2eL1�Gl Qn4 anrc� wo �N,rju� a�+r"IS. D;cfln<c�fc,nuS-an,6�e c�r�S. �
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical 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 ordina nd state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: ,� / J/
Print Name:, l4 y� A)q 1 kQ Signature Q Date t? IS / Z