HomeMy WebLinkAbout903 BUCKINGHAM ST - APPLICATIONS - 10/5/2012Planning, Developmenfi',&.Transpotta'tion
City Of r1 281 N. College Ave P.O. Box 580'
Fort C. ofli
1S Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
I
OVER' THE COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply): El conditioning
p 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 O Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make', model and
manufacturer):
Complete all applicable info tion n the application. Incomplete applications will not be accepted.SA_�' 1
Application # �.
PP.I Date
fbr offlce use only .
Sob Site Address (required) Value of constr ion (labor; materia(s, profit)
Property Owner Name Address
City/State Zip :.
Phone .
Applicant Name Address
City/State ,` . Zip
Phone
Brian`5. Sle Ar;c moo) u1c, 1410 Websfet-Ave ; 1��,Callins $ "oZ4_ �x>= $H-
Contractor Lic # Address
City/State Zip-,
"' F Phone
? ian's (Zol1jr?SICp �D52q
q76-(48q 508s
Contractor City,of Ft. Collins Sales Tax #
Are you paying taxes here or by report?.`
X. Here ❑ Report
sales tax number isrequired byall conbactols
2.193?
Are you paying with your.trust account?
❑ Yes ; �. No
Is this a residential or commerdal ,project? ❑ Residential ,Commercial
If residential, Is It: ❑ Single Family Detached,, _ , ❑, Condo/townhome (single family attached) .❑ Dup16
❑ Multifamily (apartment) ❑Garage
If commercial, is it: '.❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel Medical office O*Officel ❑ Retail
❑ Restaurant KOther (explain) j? �
Is this building 50 years' of age or more? ❑ Yes ❑ No If yes, you may need to contact H/stoNc Preservat/on_
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 L�.� r�er r� rrzj-
T
*If lawn sprinkler/backflow preventer; riust list licensed plumber. If first-time A/C, most list licensed'electncian: -
Subcontractors: List the company naimn or City of Ft Collins license # .
Electrician Plumber__ Mechanical Roofed. Other
I hereby acknowledge that I have read s application and state that. the above information is complete and correct. I agree to
comply with all requirements contained ! ..rein and city ordinances and state laws regulating buildiny construction. I know that a
permit is not valid until it has been. ;)aid and issued.
i
A licant .
PP
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Print Name: Signet D