HomeMy WebLinkAbout821 BUCKEYE ST - APPLICATIONS - 6/18/2014Fart 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
❑ Demolition (Interior non-stnxiural) ❑ Electrical A)teration (not service change) ❑ Gas Ughter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ WoodfPeilet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all appliddable Information on the application. Incomplete applications will not be accepted.
Application # AL 015N1 • Date u If'
For o/,rce c5e omlr
.lob Site Address ( hzd) Value of C nstruction (labor, materials, profit)
Pro rty. caner Name' dress City/State Zip Phone��
/f�PYI/!n , �t�'a
Applicant Name Address City/state ZI Pho e
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Contractor.. `''': ' '' Address City/State Ztp . Phone
�G'�C?o r� m �.-Ce� , r�-` �` C, CO �05� . • y'�' ��y` j`SSa
ContractorrCity of Ft. Collins Sales Tax # Are you paying taxes here or by report, • ❑ Here ❑ Report
Sales Wh nu rJ Dya//con"Um. Are you paying with your trust account? 13 Yes ❑ No
Is this a residential or commercial project? JiResidential ❑ 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 -❑,Retail
❑ Restaurant ❑ Other (explain)
Is this building 5o years of age or more? Cl Yes "o !Eyes, you may needle mrytactN�storic Pr[iserbat/oh
If this is for a demolition permit, what year was the building constructed?
!,prior to 1976, you Wil/ new an asbestos assessment to submit rvrth this applkWon.
Description of work
*If lawn spr1nkl2r/backflow preventer, must list licensed plumber. If,first-time AIC, must list llccnsed Electrician.
Subcont ors; isC fh/p parry name o' Oty o>`�t Cbi//ns tkCvrse .# ss77 ..
Electrician � ` Plumber Mechanical 1V • 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. 11knowthat a
permit is not val g until! It bas been paid and Issued. _
Applicant: y
Print Name., / v 3ignatu Date491—