HomeMy WebLinkAbout606 S HOWES ST - APPLICATIONS - 11/8/2010AFFORDABLE RFG /FCR 970207289 p.1
of
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). ❑ 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 matte, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 1 23 Date I
For offbe use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name
Address
City/State Zip`/
Phone S•
Applicant Name
Address
City/State Zip
Phone ,�
-,
_
.
Contractor
Address
City/State Zip
Phone 0
fw- U; �; :
1 ��
lv 21 1� �;�,� a ;�.� .
� � yN
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?-EI<Here
❑ Report
Salestaxnumberisrequiredbyallcontradors
Are you paying with your trust account?��eS
❑ NO
Is this a residential or commercial project? `Residential ❑ 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 11 Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ',-e6o if yes, you may need to contact Histonc Preservation
If this is for a demolition permit, what year was the building constructed?
0poor to 1975, you will nerd an asbestos assessment to submit wiDS this application.
Description of work ,'� - r I ' , f Z/k- -na 4 ^
*If lawn sprinider/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty offs 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: j
Print Name: I ! P 1 I C Signature I' `�� Date
� t
U