HomeMy WebLinkAbout4501 STOVER ST - APPLICATIONS - 1/7/2014City Of Planning, Development Sc Transportation
rty . 281 N. College Ave P.O. Box 580
Fort Collins 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). ❑ 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 # 13fgoiosC) Date
For office, use only
Sob Site Address (required) Value of Construction (labor, materials rofit)
y s'a i-5_bVtr Sfi• $ M33s
q f: o'/ 2-4
Property Owner Name &d rrlGk Address
City/State
Zip
Phone
goe-h M"i i�ry crry Wi n q^�.
%%CGIIIAi
. CD
�10 5o y3
Applicant Name Address
City/State
Zip
Phone
Pr)1 r1 a m C; N F0, 8oN /16 e ,
� ork
8ds35_
y�41 - 2 2-7Z
Contractor Lic # Address
City/State
Zip
Phone
N�)oIMtiN /Zoo/=/ /e-122z It
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes
here or by report?
ere ❑ Report
sales"taxnumber isrequiredbyall contractors,
Are you paying with your trust account?
❑ Yes ❑ No
y/od7
Is this a residential or commercial project? R!kF
If residential, is it: ❑ Single Family Detached
❑ Multifamily (apartment)
If commercial, is it: ❑ Bank ❑ Bar ❑ Church
sidential ❑ Commercial
❑ Cohdo/townhome (single family attached) XDuplex
❑ Garage
❑ Hotel/Motel ❑ Medical office [],Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ YesNo If yes, you may need to contact Hlstorlc Preseruat/on
If this Is for a demolition permit, what year was the building constructed?
If plior to 1975, you will need an asbestos assessment to submit with this application.
Description of work' lfc r'�70y(' / -,Zyy(r -746 Af eck.,tir ctiCl ivffti// 30)V1 S�iiA,s,�
*If lawn sprinkler/bacidiow 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 #
Sectridan 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: .7 �Uf vr?� Si �G`` Date l Print Name:g Signature
-7-/y