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HomeMy WebLinkAbout646 S COLLEGE AVE - APPLICATIONS - 3/18/2004Lv City of fort Collins Building and Zoning Dept. P.O. Box 580 Fort Collins, CO 80522 Phon 970-221-6760 Fax 970-224-6134 7 b� City of Fort Collins OVER=THEwCOUNTER PERMITS ONLY Use this application to apply for a permit for any of the following: (check all that apply) ❑ air conditioning, ❑ demolition (interior non-structural), ❑ electrical alteration (not service change), ❑ gas lighter, ❑ gas line, ❑ gas log, ❑ heating unit, �❑ lawn sprinkler, ❑ mobile home replacement, ❑ roofing, ❑ sewer line, ❑ ventilation, ❑ water heater, ❑ water line, ❑ wood stove (*provide model name & number). Complete all areas of the applications that are applicable to your permit request - Incomplete applications 4wl tI�accepted. An over-the-counter permit will only be valid when it has been paid -in -full and issued. Application # � Date /� �1 / d for office unse onlly) 4�� C 0 Prope&ty Ownpar Nam Address Phone Applic t Name t ,. Address I Phone W ' (S©� Contractor Name City Lic # Address Phone Contractor City of Ft. Collins sales tax # Pay taxes here? ❑ Yes ❑ No lob Site Address �. C l Value of Construction (labor, material, rofit) $ 2vDo, ,—� Is this a residential project? ❑ Yes o If residential is it: ❑ Single family detached ❑ Condo/Townhome (single family attached)) ❑ Duplex ❑ Multifamily (apartment) ❑ Garage Is this a commercial project? EfYes ❑ No If commercial is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ office .>�etail ❑ Restaurant .Other(explain) _`� �1 o tiTqe ����oj GS �L D� Is this building 50 years of age or more? Yes ❑ No If yes, you may need to get historic preservation approval prior to permit issuance. -bi (_S ( Aje ss Description of Work 1 **If lawn sprinkler/baddiow preventer installation, must list licensed plumber. If first-time A/C, must list licensed electrician. Stontractors: (list the eco company name or licenEcal Mechanical Plumbing ng Other i nemuy aamowieage mac i nave reaa mis application and state that the requirements contained herein and city ordinances and state la)Ng regula Applicant� n^ ! Print Na"met2., W,� Signature information is correct and agree to comply with all Nino consb uction. Date ,3 / `� D G 0