HomeMy WebLinkAbout6001 S COLLEGE AVE - APPLICATIONS - 3/2/2012i
City of Planningi Development & Transportation
FoY} 281 N. College Ave P.O. Box 580
rt 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 Line ❑ Wood/Pellet Stove (must be EPA certified, provide make; odgl�
manufacturer). `/�CCv'i
Complete all applicable information on the application. Incomplete applications will no a accepte .
Application # 0' 0�6 1 I 9ADate
For office use only
Job Site Address (required)
Value of Construction (labor, materi s, profit)
00
Property Owner Name Address
City/State Zip
Phone
SOD /
L' sas
970 a -4130F
Applicant Name - Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
Contractor City Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here XReport
Sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes No
Is this a residential or commercial project? ❑ Residential XCommercial
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 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 f u
Jf SY.9- 1 ot2 e r SM
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/ , must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license # 4
Electrician Plumber Mechanical Roofer Other 3 0
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:
Print Nam
Date J-�2 —/c; 2—
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