HomeMy WebLinkAbout423 BUCKEYE ST - APPLICATIONS - 4/11/2014FROM :NCR
FAX NO. :9702299983 Mar. 25 2014 11:42AM 131/4
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
0 emolltion (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 O Water Heater ❑ Water Line d 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 #y 1 `lc) 1110 _ Date
For office use only
lob Site Address (required)
Value of Construction (labor, materials, profit) ~ -
Property Owner Name M Address
Gty/State Co Zip Phone
2: 4R
Applicant Name Address
Gty/State Zip Phone
1Mr,�Y-
Contractor Address
Clty/State PV:DIk% LZip Phon Cf7)!b
r4v ✓ - 212-s
co 9M 2-4 a33
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ere CI Report
.M
_%Wtax numberisremuiredbyall ew&wlm
Q tog( j2a .._.
Are you paying with your trust account? es 0 No
Is this a residential or c9mmerclal project? XResidential ❑ 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 L7 Retail
❑ Restaurant ❑ Other (exPXN)
Is this building 50 years of age or more? 17 Yes No If yes, you Wray need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
tf pNor to 1975, you will need an asbestos assessment to submit with thJs application.
Description of work
R
*If lawn sprinkler/bacKow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
subcontractors: Llst the company name or CRY of ft Collins /Icsnse 0
Electrician Plumber Mechanal 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 Nam
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