HomeMy WebLinkAbout605 COLORADO ST - APPLICATIONS - 7/29/2013Planning, Development & Transportation
City Of 281 N. College Ave P.O. Box 580
C
�! �6rt C0ttins Fort Collins, CO 7
Phone 970-411i-274040 Fax 224-6134
OVER-THE-COUNTER PERMfTS 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. Incomplete applications will not be accepted.
Application # b( So31Y3
For o!i<ce use only
Date i- 943- i 3
lob Site Address (required)
Value of Consb
` n (labor, materials, profit)
Property Owner Name
Address
City/State
Zip Phone
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Applicant Name
Address
City/State
Zip Phone
Contractor
Address
City/State
Zip Phone
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Contractor City of Ft. Collins Sales Tax
#
Are you paying taxes here or by report? RtHere ❑ Report
Sales lox number,& required by all canbactors.
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? J'Residential ❑ Commercial
If residential, is it: lErSingle 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? ❑ Yes KNo If yes, you may need to contactHistoric 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 ELF c (z z «I
*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: /�/ANitb�
Print Names �GA��r/L�� Signature Date
IN
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