HomeMy WebLinkAbout648 STOVER ST - APPLICATIONS - 3/13/201230 +30
City of Planning, Development &Transportation
FY I 281 N. College Ave P.O. Box S80
ort 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 VWater 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 # �?)i a o 125 Date A 2A Z
For office use only
Job Site Address (required)
Value f Construction (labort materials, profit)
Pro erty Owner Name Address
,�5ov���
Ci /Sta a ZIP Phone
A plicant -Na�rn -e- Address
r 10V_Mk.CS tSameasbelo�
City/State Zip Phone
b-�q�-5a73
o tra Address City/State Zip Phone
(nor I I oEbas 11hpiRd. GcSct �� 8520Li g6b �i�i-6,Dl3
55
Contractor City of Ft. Collins Sales Tax #
Sales!axn r berg"
iS
Are you paying taxes here or by report? 5aHere ❑ Report
Are you paying with your trust account? B'� ❑ No
�RU iSt
Is this a residential or commercial project? 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(explaln)
Zs this building 50 years of age or more? ❑ Yes Oo Ifyes, 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
a. 7t
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list Iicensed 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 bullding construction. I know that a
permit is not valid until it has been paid and issued, .
Applicant: �)
Print Name:�rI v�
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