HomeMy WebLinkAbout1418 SALEM ST - APPLICATIONS - 9/19/2011of
Fort 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). ❑ Ai Conditioning
0 Demolition (interior non-structural) El Electrical Alteration (not service change) Gas Lighter l9`as Log
0 Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement O Roofing _❑ Sewer Line 0 Photo -voltaic
Ventilation p Water Heater 0 Water Line 0 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.
2
Application # Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
7 *t4f_ 1
erty Owner Name
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Address
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City/State Zip
NO S 11 R-Cvw-s
Phone T5
CO 305sf
Applicant Name
Address
City/State . Tip
Phone
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Contractor Lic #
Address
City/Sta Zip
Phone.
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Contractor City of Ft. ollins Sales Tax #
Are you paying taxes here or by report?
13 Here gReport
Sales tax number is required by all contractors:
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? ,9 Residential ❑ Commercial
If residential, is it: ® Single Family Detached ❑ Condo/townhome-(single family. attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is lit: - ❑ Bank ❑ Bar, ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building SO years of age or more? ❑ Yes ❑ No If yes;; you may need to contact Historic Preservation
If this is fora demolition permit, what year was the building constructed? _
Ifprror to 1975, you will need an asbestos assessment to submit with this application.
Description of work rt�D!DL et-<_A"��A �C»c(Z fLr�yc- — ii^Ss'►w
*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 #
Electridan 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:
Print Name��` - . _ 'ri0&1-- _ Signature
Date