HomeMy WebLinkAbout4444 STOVER ST - APPLICATIONS - 11/17/2011City Of Planning, Development & Transportation
Fort Collins Fort N. College Ave P.O. Box 580
Collins,
CO 80524
Phone 970-41616-27402740 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 sery a 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 nfgrmati n on the application. Incomplete applications will not be accepted.
Application # (l���/'/ �` 11 e
For office use only 0lr 1 —
7o site'AJdress (required) Value of Construction (labor, materials, profit)
�%yy S 90ve4l� .S� $ 230D —
Property Owner Name
Address
City/State Zip
Phone
Applicant Name
Address
City/State Zip
Phone
n1 /,41
60 'S�53F'
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Contractor
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lac # Address City/State Zip
-203 3/S.�/ ,?� �L lielwu�0 053S
Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
ere ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? KResidential ❑ Commercial
If residential, is it: CJ.Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
ultifamily (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 will need an asbestos assessment to submit with this application.
work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electridan 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: /
Print Name: Signature Date