HomeMy WebLinkAbout600 REPUBLIC DR - APPLICATIONS - 10/5/2011�lornmel��G Ga>/•Co�
Fort Colfins
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 nonstructural) ❑ Electrical Alteration (not s`er ice change) ❑Gas Lighter ❑Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement p Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑Water Heater ❑Water Line ❑ Wood/Pellet Sto/vei (must be EPA certified, provide make, model and
manufacturer).
Complete all applicaab�le Informqonrn the application.
Application # I J ` `yy
For o>TAx use only
Incomplete applications will not be accepted.
00Date
lob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name
Address City/State Zip Phone
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icy- tar. F! . oI 1 ns
Applicant Name
Address City/State Tip Phone
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Contractor
Address City/State Zip Phone
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Contractor f Ft Collins Sales Tax
# Are you paying taxes here or by report? ❑ Here XReport
sales tax number isreQuimdbyaumntraa m
Are you paying with your trust account? Yes ❑ No
Is this a residential or commercial project? OResidential ❑ Commercial
If residential, is it..Single Family Detached ❑ Condo/bownhome (single family attached) ❑ Duplex
d Multifamily (apartment) ❑ Garage
If commercial, is rd ❑•Bank ❑ Bar ❑'Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? 0 Yes ❑ No If yes, you may need to contact HistwAc Prervadon
If this Is for a demolition permit, what -•,year was the building constructed?
r4dor to 1975, you wi// need an asbestos assessment to submit whir this aAWlcadon..
Description of work 1 P S Si _ C iU
.tlr e-r- I LL I vy-ff :1 sr
*If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: list the cwwny name or 9W of ft Collins license.'
9ectrlc Plumber Mechanical Roofer — Other
I hereby acknowledge that I have read this application and
comply with all requirements contained herein and city ordi
pennit is not valid until It has been paid'and issued.
A Print Na : r o-U Cau :Print Name: rl ll Signature
that the above information is complete and correct I agree to
s and states laws regulating building construction. I know that a
Date I p l5l�gc I I