HomeMy WebLinkAbout604 DUKE LN - APPLICATIONS - 2/20/2014Fort 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). ❑ 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 St a (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will
not be accepted.
Application #_� IN 01�6 Date _{�2( ,1 ^ 1 `1'
For office use only
Job Site Ad s (r
wired)
Value of Construction (labor, m terialsiafit)
LOC
P
Lin
ty Owner N
Mm,lo
Address
Du
City/State Zip Phone
-a 49p
he
a
OS
A pli t Nam %&
dress 1/b
44 Address
E
City/State Zip Phone
�i
I o 5� '%Zoo
Contractor
Address
T�_Pa�
City/Stat Zip Pho
ul-irs n
mk
Contractor City of Ft. Collins
ales Tax #
Are you paying taxes here or by report? ere ❑ Report
Sales tax number 7requirejibyall contractors
Are you paying with your trust account? Y s ❑ No
Is this a residential or)Kmmercial project? _ 15-2
If residential, is it: K13,,Single Family Detached
❑ Multifamily (apartment)
If commercial, is it: ❑ Bank ❑ Bar ❑ Church
sidential ❑ Commercial
❑ Condo/townhome (single family attached)
❑ Garage
❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other (ex
Is this building 50 years of age or more? ❑ Yes
yVo If yes, 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.
of
*If lawn sprinkler/backFlow preventer, must lift licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of At 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: j
Print Nam Signature
Date
?ab