HomeMy WebLinkAbout628 ENDICOTT ST - APPLICATIONS - 3/26/2012 (3)City of Planning, Development & Transportation
�+t Collins 281 N. College Ave P.O. Box 580
Fort Collins, CC
Phone 9J0-416-27402740 Fax i24-6134 y �}!�"
OVER-THE-COUNTER PE�RIVII° ONLY 3a 'l \
This application is to be used to apply for the following permits only (check all that apply). O Air Conditioning
0 Ceniditior, (interior non-structural; G (Electrical Alteration (not se vice change) C Gas Lighter O Gas Log
D Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement C Roofing O Sewer Line ❑ Photo -voltaic
l:I Ventilation 0 Water Heater 0 Water Line O Wood/Pellet Stove (must be SPA certified, provide make, model and
manufacturer).
Complete all apptic le Informstion/on t e appl lion. Incomplete applications will not be accepted.
Application #_��(� Date
For offce use only
Job Site Address (required Value of Construction (I , materials, p
Prope( ty ?caner Name Address
, City/State Zip Phone
j
i Applicant Name Address ``
City/State j Zip Phone
Contractor Lic # Address
C /State Zip Phone
Jut
Con'tractor City of Ft. Collins ales Tax #
Are you haying taxes here or by report? 2CHere 0 Report
saes tax r by T?//co i-actors
Are you paying with your trust account? Q Yes 0 No
Is this a residential or c mercial project? 0 Residential 0 Commercial
Ii' residential, is it: " E3 C7 Condo/towniomeisingle family attach' d) ❑ Duplex
iY (apartment) Multirami ag Gar a .f � i
If commercial, is it,.: 0 Bank ❑ Bar 0 Church 0 Hotel/Motel ❑ Medical office i7 Office ❑ Retail
i ® Restaurant E3 Other (e lei)
:s this building 5tD years of age or mare? O Yes 4o If yes, you may need to contact Historic Preservation
:Ef this Is for a demolition permit, what year was the building constructed?
J tv 19751 you will need an asbestos assessment to sutvnit with this application.
*I` lawri sprinkler/bacldlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractoas: List Lhee company name or Oty of ff ^chins Lane #
Plumber Mechanical ___ Roofer Other
I hereby acknowledge `hat I have read this application and state that the above information is coriplete and correct. I agree to I
! cornply 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.
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