HomeMy WebLinkAbout900 S COLLEGE AVE - APPLICATIONS - 6/2/2013Ot of Planning, Development & Transportation
C y 281 N. College Ave P.O. Box 580
�;,�Or` Collins Fort Collins, CO80524
� `,- 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 # ;� I i30 aCp ;q
For ofce use only
Incomplete applicatio s will not be accepted.
Date � 1Z 63 4? —/ 0—
lob Site Address requied) Value of Construction (labor, materials, profit)
L� G' $ w
Property Owner Name Address
5e,•e /6"14
City/State
'01 w--
Zip Phone
a 07
Applicant Name / - Address
City/State
Zip Phone
Contractor Lic # Address
"
City/State
Zip Phone
91444 .4e/9K7
Con actor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? 'Here ❑ Report
Sales lax number is required by all contractors
Are you paying with your trust account? ❑ Yes MNo
Is this a residential or commercial project? INkesidential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached)
IZ-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 UNo 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 l aY
o SPA C s et i P1 0-1
at —w�
*If lawn sp nkler/backflow preventer, Midst list li ensed plumber. If first-time A/C, must list licensed electrician. ', /
Subcontractors: List the company name or City of Ft Collins license # ff
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 la regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: ` ',/
Print Name: I N EN Signature Date 2 ,�