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HomeMy WebLinkAbout628 ENDICOTT ST - APPLICATIONS - 3/26/2012 (2)City of Planning, Development & Transportation F�*�.t�+# 281 N. College Ave P.O. Box 580 WA ` Collins Fort Collins, CO 80524 Phone 970416-2740 Fax 224-6!34? '-'ay OVER-T IE-COUNTER ■ ERMITS ONLY This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning © Darnolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter G Gas Log 1-1 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line 0 Photo -voltaic © Ventilation ❑ Water Heater ❑ Water Lire 0 Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applic to information on the application. Incomplete applications will not be accepted. Appkation # - -,%]Z Date For office use only �3odr Site Address (required_ I Value ; n on (labor, materials, pr i !1 $ 3' Property st?wner Name Address r City/State Zip Phoneif 00410 Applicant Name Address City/State Zip PhoneAlims Oft Contractor Lic # AddressCity/State Zip Phone Contractor City of Ft. Collins ales Tax # Are you paying taxes here or by report? XHere D Report jSalesrax by allcontrcxmrs. Are you paying with your trust account? ❑ Yes ❑ No Is this a residential or co ercial project? ❑ Residential ❑ Commercial I` residential, is it:1 ❑ Condojtownhome (single family attached) ❑ Dupkex Muldfamiry (apartment) Warage If commercial, is it: ❑ Hank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ office ❑ Retail 0 Restaurant ❑ Other (e ai .) Is this building 50 years of age or more? ❑ Yes o If yes, you may need to contact Historic Preseivatfon If this is for a demolition permit, what year was the building constructed? If pnor tel 1975, you will need an asbestos aspessment to submit wibi this appllcatfon. 0 0 *If !awn sprinkler/backtlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors. List the company name or ©ty of Ft Coffins &-et se # Electriaan _ Plumber Mechanica!— Rooter Other I her6l y acknowledge that I have read this application and state that the above information is complete and correct. I agree to comply wild all requirements contained 'herein and city ordinances and state laws regulating building constructen. I know that a permit is not vaild until it has been paid and issued. Applicant: Print Nave Jam__ — Signatu Date k,