HomeMy WebLinkAbout632 ENDICOTT ST - APPLICATIONS - 6/24/2013City of
F:Ort Collins
Planning, Development & l
281 N. ,College Ave P.O. Box
Fort Collins, CO 80524
Phone 970-416-2740 Fax 2�
OVER -THE -(COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditic
❑ 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. Incomplete applications will not be accepted.
Application # fJ I_0 31 aV Date -/ 3 LP -1
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
�1
1
0 o
Property Owner Name Address
City/State Zip
Phone
3a -�
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9 5�93 a>
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Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
36 1
Contractor City oil Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ` •Report
5ale5 rax numberisngvired by all contractors
Are you paying with your trust account?
❑ Yes No
Is this a residential or commercial project2 t34Residential ❑ Commercial
If residential, is it: l�Single Family Detached ElCando/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? ❑ Yes ❑ No Ifyes, 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 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 oft Collins license 'o
BectriciafQ)' Plumber Mechanical Roafer 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:
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