HomeMy WebLinkAbout806 W MULBERRY ST - APPLICATIONS - 5/14/2013Fort 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 information on the application.
Application # F21 30�-)252.
For o>tice use only
Incomplete applications will not be accepted.
Date 1� /q 1-0 1 '�)
Sob Site Address (required) Value of Construction (labor, materials, profit)
$ Sbc7 u o
Properly Owner Name Address
City/State Zip
Phone
Applicant ame Address
City/State Zip
Phone
Contractor Lic # Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying -taxes here or by report?
❑ Here ❑ Report
Sales tax number isrequired byall contractors.
Are you paying with your trust account?
❑ Yes 4NO
Is this a residential or commercial project? EXAesidential ❑ Commercial
If residential, is it: IOSingle 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? C�Yes ❑ No If yes, you may nee# to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? D
If prior to 1975, you will need an asbestos assessment to submit wibi this application.
Description of work gftii12 (JF dA10F P_ 0i), t6
*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 -Print Name: �f NYYI VY'4 L LI�' &( LO nature L I / 1/� Date /5-W15