HomeMy WebLinkAbout432 HAVEN ST - APPLICATIONS - 4/3/2014CI Of Planning, Development & Transportation
� tY} 281 N. College Ave P.O. Box 580
�` Collins
IS 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 I<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 # 3 / y D/ 5 _R6 Date 4 —�
For o>irce use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
d
Property, Owner Name Address
City/State Zip
Phone( 7,3
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5.6,11t 8Ds
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Applicant Name Address
City/State Zip
Phone-��
Contractor Address
City/State Zip
Phoneft-)O)
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inn d c F-t_ (-' 11 i n's Cam
-81
Contractor City of Ft. Collirq Sales Tax #
Are you paying taxes here or by report? XHere
❑ Report
Sales tax number isrequiredbyall contractors.
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: JaSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank El Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes V-No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will need an asbestos assessment to submit with this application.
Description of 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 #
Electrician
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: L-0-y-oLl nri�-(Signature ��/ �i../l n Date Y—� / /