HomeMy WebLinkAbout825 AZTEC DR - APPLICATIONS - 8/3/2011City
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 XFRoofing ❑ 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.
Application #
For office use only
Incomplete applications will not be accepted.
Date _&/311
Sob Site Address (required) Value of Construction (labor, materials, profit)
�a s Azlec �
Property Owner Name Address City/State Zip
61eUe - u-ckej �2-70& !) Si uce?-yL S4a. r-i-C Fa2,(e
Phone q3 -
.
2/
Applicant Name Address
City/State Zap
Phone
Contractor Uc # 1- 1-1X5 Address
City/State Zip
Phone q-10
Ko OL 11 L4-\\Zu n
oo�er a e y5 S t_i (_
ULVAL ETC, C-v 50t0y
27-y -)lZ-00
Contractor City of Ft Collins Sales Tax # 75--JU
Are you paying taxes here or by report? ❑ Here
_
XReport
sales tax number is required by all contractors
Are you paying with your trust account? (Yes
❑ No
Is this a residential or co mercial 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 ❑ 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 prior to 1975, you wi// need an asbestos assessment to subm/t wilfi this app/icabon.
Of
*If lawn sprinkler/backnow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the company name or Gty of Ft Collins license # 9W 4A
Electrician Plumber
I/7
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 been paid and issued.
Applicant:
Print Name: Signature /�f� `" Date J01 3