HomeMy WebLinkAbout418 GUILLEMONT ST - APPLICATIONS - 11/2/2011NOV/02/2011/WED 12:11 PM FAX No. P.001
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of Planning, Development &Transportation
City
81 N. College Ave P.O. Box 580
F6r` Collins, Fort Collins, CO 80524
Phone 970-416-2740 Fax 22+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 X Roofing ❑ 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. Incomplete applications will not be accepted.
Application # I\\ to D b (V Date
For orYce use only , ZAq��
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
/State Zip P one
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Applicant Name Address
City/State Zip Phone
Contractor Address
Gty/State Zip Phone
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Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report? A Here ❑ Report
sales tar numberisregryedbyall cantraaws
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/toivnhome (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 Ifyes, you may need to contact HistoricPreseruation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you w111 need an asbestos assessment to submit with this appiicatlon.
of work
ea
*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 Rooter
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.
Applica t: + `
Print Name: J �' I 1 �.� _ r,r.Q 0 f—Ai signature y Date