HomeMy WebLinkAbout921 W OAK ST - APPLICATIONS - 3/25/2013Fort 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 informisf ion on the application. Incomplete applications will not be accepted.
Application # 8ISD Ia?"L Date S / 1
For ofce use only
Job Site Address (required) Value of Construction (labor, materials, profit)
&i ?- l W . o 1�-1L S-r 1 $ - 0
Property Owner Name Address
City/State Zip
Phone
VANL-1\Q A,a\ U)). c
cT Tovt-rcci-cNn5> &�-v -SRPPa
Applicant Name Address
City/State Zip
Phone
56-'-tA
Contractor Lic # Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? 8 Here
❑ Report
sales lax number is required by all contractors
Are you paying with your trust account? ❑ Yes
H 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? [9 Yes ❑ 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
*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 ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: / 13
Print Name: �F��nn��eiJ OA -; \\Q Signature Date