HomeMy WebLinkAbout613 FLAGLER RD - APPLICATIONS - 9/6/2013Frow Poudre Valley Air, 9704932073 09/06/2013 10:11 #534 P.001/002
Fort Of
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). EpAir Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
` PHeating 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 # E 0yS CI(c Date g1LA13
For office use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner ame Address
City/State Zip Phone
Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
Lk3
Contractor City of Ft. Collins Sales Tax #
Sales tax number rsrequired byall contractors.
Are you paying taxes here or by report? ❑ Here 1&Report
Are you paying with your trust account? 'KYes ❑ No
Is this a residential or commercial project? `Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
0 Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No rfyes, 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
*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 offt 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: lC\�r Ak- aQ S\V4C\ Signature Z�.g k a Date