HomeMy WebLinkAbout618 HOLYOKE CT - APPLICATIONS - 9/26/2011Fort of
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
13 Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement ❑ Roofing 0 Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make; model and
manufacturer).
Complete all applicable informatio on the application. Incomplete applications will not be accepted.
Application # _ _ _.. - Date
For Sno use only pi
I lob Site Address (required) I Value of Construction (labor, materials, profit) I
So,-- W s -OAo.w $ 3 S s 9,-
Property Owner Name
Address
City/Stage Zip
Phone
-11 rN M1ArV YL-
6W H-o/
nke. CX C0 % 5 ZS
F Z11 -10 l o
Applicant. Name
Address
City/State Zip
Phone
Contractor Lic #.
Address
City/State Tip
Phone
sToak'k
IFOSTS
Sins -1663
Contractor City of Ft, Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here MReport
sales tax number is req&md by ail mnmacwm
Are you paying with your trust account?
0 Yes ❑ No
yYbS� '
Is this a residential or commercial project? 2 Residential 0 Commercial
If residential, is it t& Single Family Detached 0 Condo/townhome (single family attached) ❑ Duplex
0 Multifamily (apartment) ❑ Garage
If commercial, is it 1 Bank ❑ Bar ❑ Church ❑ Hotel/Motel 0 Medical office 0 Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
if pnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work .- &ix (2-s" u. / cc- QK ; o . -36..
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name or Gty 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.
Applicant: Ga�,K
Print Name: Signature 1�. Date