HomeMy WebLinkAbout4700 S COLLEGE AVE - APPLICATIONS - 11/22/2013FROM :kessler FAX NO. : Oct.22 2013 08:01RM P1
Fort of
Planning, Development & Transportation
281 N. College Ave P.O. Hoc 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 permita only (check an that apply ❑ Air Conditioning
❑ Demolition (interior non-structural) 0 6fectrfcai Alteration (not service change) ❑ Gas Lighter 10 Gas Log
❑ Heating Unit DLawn Sprinkler 17 Mobile Home nalAkement XRoofing O Sower Line 0 Pholo voltaic
11 Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/pellei Smve (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the atanihmdon. Incomplem applications will not be scceptad.
Application / J �'l `T T pate
For ofte use an/y
Job Site Address txq") Value of Construction (labor, materials, prolit)
4700 S Cn0coe P 1p 1 $ SOb() SU G
Property Owner Name Address City/Stabe Zip Phone
suZwnoe Skei n6,ke.� a1 e-v Dr (:TC CU 8052S 22(o ` 'j
Applicant Name Address (XV/Sb to Zip Phone
Contractor t!c #R 122F Address t:tty/State Zip phone
A/4 t �`2i , v ,rt�� fish (�iG�A,C�/f1 : PTC.
Contractor City of Ft Collins Sales Tax #
Sales tax numtkrB nrgrdreSbyaN �
Are you paying taxes here or by report? ❑ Heine Report
Are you paying with your trust account? )'Yes 0 No
Is this a residential or commercial project? ❑ Reddential A eommarciat
If residential, is it: 0 Single Family Detached ❑ Corulo/eownheme (single family attached) 0 Duplex
(3 MuWamlly (apartment) I❑ Garage
If commercial, is it: 0 Hank 13 Bar O Church Ct Hotel/Motel ❑ MedW offloe , office, 13 Rem
❑ Restaurant 0 Other (apiain)
Is this bullding SO years of age or mare? o yes AZNo sye� youmeyneed to f//shxiiPr�ertse ri
If this is for a demolition permit, what year was the building oonstrudled?
Ifpnbr lD 1975, )cv wNneed an asteftw amaRuno tto sWunt M*h &&ayop rx
of work (eo. r off e x; ,!t i no roo_'.,,4. A o o l„ u
*If lawn sprinkler/baddfow preventer, must Ifst lensed plumber. if first-time NC, must list licensed damtk n.
Submntra Wm. LAW ftWmpanynu7WorOWofRCA tW&WisejF
Plumb der P� of
I hereby acknowledge that I have read this application and staee that the above Wormaeon is 0=0ete and conett. I agree to
comply with all requiremerft contained herein and dty orditarrAms and sutra laws regulating building construcitm I in that a
permit is not valid until It has bow paid and issued.
glint r tm