HomeMy WebLinkAbout920 N MASON ST - APPLICATIONS - 5/12/2014Planning, Development &Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVE THE -COUNTER PERMIT'S 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) O Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement A 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 #,X;i" t tf0Z3a Date �l/2.
For office use only
Job Site Address (requ/red)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip
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Applicant Name Address
City/State Zip
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Contractor Address
Ity/State Zip
Phone
Contractor City of Ft. Collins Sales Tax g
Are you paying taxes here or by report? ie ❑ 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? 917 Residential ❑ 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? ❑ Yes ❑ No If yes, you may need to contact Histon'cPreservation
If this is for a demolition permit, what year was thd-building constructed?-
Ifionor to 1975, you will need an asbastm assessment to submit with dais application.
Description of work Qr- +- —,Ag 6ce et X - srl til q
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*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the company name Or Clty of Ft Collins !!cane #..
Electrician Piumber Mechanical Roofer R- i8$q 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.
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Applicant: i•, ; :--._
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Print Name >� vu< �e� i riGi S Signature Date
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