HomeMy WebLinkAbout804 ALTA VISTA ST - APPLICATIONS - 2/28/2012Cityof Planning, Development & Transportation
C rrr��� 1 281 N. College Ave P.O. Box 580
1 t Collins 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 ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water LineWood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable informations on the application. Incomplete applications will not Pe accepted.
Application # rJ �� - l Z CP Date
For office use only ✓ T o°t
Job Site Address (required) Value of Construction (labor, materials, profit)
bov Al- V15-1n- s� $ 5ozo ,
P perty r Name Address
City/State
Zip
Phone
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Appl� ame Address
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City/State
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Zip
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Phone
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ontra��ll Lic # Address
City/State
Zip
Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ;! -Here ❑ 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? A.Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Restaurant ❑ Other (explain)
❑ Duplex
❑ Retail
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?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work 57, LL actr&. I e /DD arc d >IT/_—Wpogi
*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 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.
PP
Print Name: U L u l� Signature / Date '�z aU