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HomeMy WebLinkAbout836 CORONADO AVE - APPLICATIONS - 10/7/2011OCT/0V2011/FRI 12:52 PM FAX No. P, 004 FCity, of 3�3Sq 3 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). CI Air Conditioning ❑ Demolition (interior non-sbuctural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement JV Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation ❑ Water Heater ❑ Water Une ❑ 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, bl Application # 511 U 8 5 q a Date lC�l�l� [���_ _ 9 —1 • �0 For oltice use only Job Site Address (requlmd) Value of Construction (labor, materials, profit) 1 Property Owner Name Address City/State Zip Phone C00. C� Applicant Name Address City/State Zip Phone Collb-actor Address City/State Zip Phone 5075; tf N7 oi✓i '7 Contractor City of Ft. Collins Sales Tax N Are you paying taxes here or by report? X Here ❑ Report sa�©rn�� 4.pquredbyaacvnbactrxs Are you paying with your trust account? ❑ Yes ❑ No Is this a residential orSommercial project? 1p Residential © Commercial If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) Q Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel O Medical office ❑ Office D Retail ❑ Restaurant ❑ Other (explain) Is this building 50 years of age or more? O Yes O No If yes, you may need to contact Historic Presevadon If this is for a demolition permit, what year was the building constructed? lfpnor to 1975, you wi//need an asbestos assesw7xv7t to submit with this application. of work VZ *If lawn sprinklerybacktlow preventer, must list licensed plumber. If first-time P./C, must list licensed electriclan. Subcontractors: List Me company name or City of Ft Collins license # Electddan 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: PrintName:ml�- �`,,f, 0f—"Q Signature OateAtU �