HomeMy WebLinkAbout600 E COY DR - APPLICATIONS - 5/1/2014From:
05/30/2014
06:22
0096
P.003/005
s:�)-C)f
City of
F6rt Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580 .
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OAVER-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 ❑ 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 # a i LA o QA l-1 Date T'\,\�y
Por ogre use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Z
Property Owner Name Address
City/State Zip Phone
try �M ZI a b-D 1b5o
Applicant Name Address
City/State Zp Phone
Contractor Address
City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? O Here .Report
saiertax number isrequired byauwntracrors.
Are you paying with your trust account? Yes 13 No
Is this a residential or commercial project? gazesidential ❑ Commercial
If residential, is it: Wingle 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 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?
rf prior to 1975, you will need an asbestos assessment to submit with this applicadon.
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 Cfty of ft Collins license #
Electrician 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: t�
Print Name: � \r<CD\P Signature ,�,�t�,Q � , . iw._ Date