HomeMy WebLinkAbout4700 S COLLEGE AVE - APPLICATIONS - 10/22/2013Fort Collins
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). 0 Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
O Heating Unit ❑Lawn Sprinkler ❑ Mobile Home replacement XRoofing ❑ 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 # bkbps 5 Date 10' 2� (3
For ofte use only
Job Site Address (requlred) I Value of Construction (labor, materials, profit)
4?00 S Cn(leoe 11vp
Property Owner -Name Address
City/State .
Zip
Phone
.Suzanne Skeinbicker okn,
Dr FTC C0
805ZS
22(o- 0(e133
Applicant Name Address
City/State
Zip
Phone
Contractor Lic #R122.�% Address
City/State
T.1p
Phone
A'EsSL &5ZRa0'0r1n/& , 62S ViCrfab1 PR: Fre co
em;;zg 07o�4&7-6'8z
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here WReport
Sales tax number isre Lfffed by all comractom
Are you paying with your trust account?
XYes ❑ No
Is this a residential or commercial project? 0 Residential )4 Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/bownhome (single family attached) ❑ Duplex
❑ Multifamily (aparbTient) 0 Garage
If commercial, is it 0 Bank 0 Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ,d Office ❑ Rail
0 Restaurant ❑ Other (explain)
Is this building SO years of age or more? ❑ Yes ,WNo Ifyes, you mayne3ed-to cnnt3&HlstonicAws&rvaffon
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos am es wment to submit wA this applka&on.
Description of work f ea e Y *, t i rA roof I �+
PQVe '? Q0.6- l Ana . Aoo(v C.5rn;
*If lawn sprinkler/backflow preventer, must list licensed plumber. If firs -time A/C, must list licensed electrician.
Subcontractors:Llstthe company name orGtyofftCollins llkwm9
SecMdan Plumixq Merhadca 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 Namege rte led V c,-&Lov- Signature pate (b f 22/ 13