HomeMy WebLinkAbout418 LINDEN ST - APPLICATIONS - 5/19/2011-.:y.; d�hnhi'#3`A`�.,..J„a Y . .'%�a-��+�"..::y^ _ .•ci�+,e�ts'.3 0: •�:'S�a"'`Pi4"C>a'tva?.Six !."�..-aTxBi � �aE"''�:. ,,.;!i65'�e`�.''.
City Of Planning, Development & Transportation
F6} 281 N. College Ave P.O. Box 580
r 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 # .6110eg-s—F0 Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, pro'lit
Yl S IA -slats 4'�J" C U DS�� Y $ D Z , 47p0
Property Owner Name
Address
City/State
Zip
Phone
qlr
co
Applicant Name /1
Address
City/State
Zip Phone
G.0 Y-0 513 37.
2 3 7
Contractor Lic #
Address
City/State
Zip
Phone
A...
Pd,P
G O
Contractor City of Ft. Collins Sales Tax #
3 5- 5-5'5
Are you paying taxes here or by. report? ❑ Here
0 Report
Sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes
❑ No
Is this a. residential or commercial. project? ❑ Residential a Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant 13 Other (explain) &m*40*- V-z," P-41,," A-----"
Is this building 50 years of age or more? ❑ Yes P No 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.
Description of work ��► �,�.,t
*If lawn sprinkler/backflow 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 #
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.
I
Applicant:
Print Name:^lp `JC' f1 b0 e�' Signature !' /- Date 1�