HomeMy WebLinkAbout605 BIRKY PL - APPLICATIONS - 11/29/201312-03-13;08;02AM; ;970-484-4448 # 4/ 10
Fort of
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 22+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
`� 1 leating Unit ❑ Lawn Sprinkler El 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 # bU'6 Date _ �/-a el- �3
for oKrce use only
Job Site Add ess (raqulred)
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value of Construction (labor, materials, profit)
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Property Owner Name
Address
City/State Zip
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Contractor City of Ft. Collins Sales Tax #
Sa/estax numbe 1,5-=uzred by all contractors
Are you paying taxes here or by report? ❑ Here ; keport
Are you paying with your, trust account? Yes ❑ No
Is this a residentialYCC3
mmerclal project? Residential ❑ Commercial
If residential, is it:Single Family Deta ed ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office Cl Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or morel ❑ Yes O No Ifyes, 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: Ust the company name or Gty of Collins Ilcense 0
Electrician Plumber Mechanical Roofer Other
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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 Stage laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant:
Print Name:CrAA signature
tj Date / I ~dc