HomeMy WebLinkAbout1320 STOVER ST - APPLICATIONS - 10/11/2012Oct 11 12 05:36p Rues, LLC 970-619-8074 p.2
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 Sprinklerl ❑ 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 O02OU (C)4 Date I )-
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
perty Owner Name Address
City/State Zip
Phone
1320
buY 9. $ WQ4
Q21- 525
Appli nt Name Address
City/State Zip
Phone
Wo fS (20& 44 puf 48
A(e k)
W3 �ob2r
Contractor Address
City/State Zip
Phone
Atzfawt oyi 2 uuur 4& 1DeX1
805
LAPS • 2
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? �B Yes ❑ No
Is this a residential or commercial project? WResidential '❑ Commerdal
If residential, is it: 1314-ingle Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Jfyes, you mayneed 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 applicah'on.
Description of work 1 YK �fl D LW41 f- �1 Poi 2r
*If lawn sprinkler/backtlow 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 ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant -
Print
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Print Name: cJ rzi Kk1kjht Signature Date + I 2