HomeMy WebLinkAbout608 S COLLEGE AVE - APPLICATIONS - 6/14/2013From:Poudre Valley Air 9704932073 06/14/2013 08:08 #291 P.002/003
City/}of { I Planning, Development & Transportation
281 N. Ave P.
.City
Co `i t �1 1S Fort Co lints, lege CO 80524 O. Box 580
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).: it Conditioning
N❑demolition (interior non-structural) ❑ Electrical Alteration (not service change) El LighterElGas Log
esting 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 # 13 / 300g14 (o Date
For ofte use only rm
Job Site Address (required)
Value of Construction (labor, materials, profit)
Va d
Property Owner Name Address
City/State Zip
Phone
�rU1�S�
Applicant Name Address
Clty/State Zip
Phone
Contractor Address
C ity/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here 0 Report
Sa/wtax number Isreequimdbyall carvactors
Are you paying with your trust account? Kyes
QNo
Is this a residential or commercial project? lapesidential ❑ Commerdal
If residential, is it: tDingle Family Detached ❑ Condo/bownhome (single family attached) - - ❑ Duplex
p Multifamily (apartment) ❑ Garage
If commercial, Is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant 13 Other (explain)
Is this building 50 years of age or more? O Yes ❑ No If yes, you mayneed to contact HAstor/c preservation
If this Is for a demolition permit, what year was the building constructed?
If prior to 1975, you w/// need an asbestos assessment to subm/t w&h this apphlcadon.
Description of work
*If lawn sprinkler/baddlow preventer, must Ilst licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty of Pt Col/ins rxense ,C
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:NC.Cb\+AQ)NTM. Signature v._
1�.$�,;, Date