HomeMy WebLinkAbout1320 SAINT JOHN PL - APPLICATIONS - 2/28/2012City Of Planning, Development & Transportation
y} 281 N. College Ave P.O. Box 580
Forrrr��l Collins
IS Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apfor the following permits only (check all that apply). ❑ Air Conditioning
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❑ 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 3
manufacturer). J4�
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #
For office use only
Date
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name
Address City/State Zip Phone
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Applicant Name U
Address City/State Zip Phone
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Contractor
Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax
# Are you paying taxes here or by report? 9 Here ❑ Report
Sales tax number is required by all contractom
Are you paying with your trust account? ❑ Yes �S*No
Is this a residential or commercial project? Jk Residential ❑ Commercial
If residential, is it: Nlingle 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.
Descriptio of work ?rs}c Gec iza S-ib e/ Fix e.Qaba6Wkr c ui Met4f
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*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.
Applicant:
Print Name:DqyK (00u-4t-le'_ Signatu
Date -:1 �8 ��