HomeMy WebLinkAbout825 SMITH ST - APPLICATIONS - 8/7/2012City Of Planning, Development & Transportation
281 N. College Ave P.O. Box 580 .
F6rt Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE—COUNTER PERMITS ONLY I�21P
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
I9 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 24Water 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 # l Z_I b lk thI Date -7 ' '2
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
�z5 Sw,� % S� Dorf <olli�s to so> 2`//5�� "
Property Owner Name Address
City/State Zip
Phone
0bo✓e
Karl l,/ •c�« 4-P,,-%l, PC, dPr r., sf
970 Y93 y5-93
Applicant Name NJ Address
City/State Zip
Phone
above
Contractor Lic # Address
City/State Zip
Phone
N1
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.
Are you paying with your trust account?
❑ Yes ❑ No
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? RrYes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? 1 yZo --;
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of workgW+ Re wIrt tns'"lt new ttiIl4-r l';'c 7/• Srr/c + detr 4
*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 IMechanical 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 Pt. �(Gr�fiL z / 6`�
Print Name: Q tq r ti s Signature �—� Date