HomeMy WebLinkAbout1320 YOUNT ST - APPLICATIONS - 2/13/2012City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
FtCoWns
Fort Collins, CD 80524
" Phone 970416-2740 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 ❑ 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 # b 1900 I Date ab3//'
For ofte use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name
Address
City/State Zip
Phone
Applicant Name
Address
City/State Zip
Phone
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Contractor
Address
City/State Zip
Phone
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Contractor City of Ft. Collins Sales Tax
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Are you paying taxes here or by report?
❑ Here ❑ Report
Saks taxmrmbercsreworedbya#mnnados
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? g Residential ❑ Commercial
If residential, is it OSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If Commercial, is it: ❑ Hank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
. ❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yas, you may need to contact Historic Preservabon
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you wi// need an asbestos asseSsmentto submit with this application.
Description of work '✓b-J �. - ",.� ° v:� • -r:. z ,: �.: S c..
*If lawn sprinkler/baddbow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician -
subcontractors: LaMecompany name orCtyofRCollins license0
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 stage laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant , : = %
Print Name % . : ; gnature = Date a/ 131f a