HomeMy WebLinkAbout903 BUCKINGHAM ST - APPLICATIONS - 6/27/2014of
FF6rt Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # ?A L4®J_Z1gL' Date 6102 �z
For office use only
Job Site Address (required) / Value of Construction (labor, materials, profit)
Property Owner Name
Address City/State Zip
Phone
%—
970-5 id-,2 4
Applicant Name
Address City/State Zip
Phone
L3riGln'S 1�,�r c. Co,1 c li(lo Web Ave. iF+.Col(�nsCfJ �oro2�f 9� �y
Contractor Lic #
Address City/State Zip
Phone
b6gc-'s ElecFric, ME- 131
IyloWebs+,erAve, 'FkC0U;netC0 !8�l52y
47o-q,? .50?'5
Contractor City of Ft. Collins Sales Tax
# Are you paying taxes here or by report?
9 Here ❑ Report
Sales tax numb erisrequiredby8/I mntradnrm
2I 7
Are you paying with your trust account?
❑ Yes No
Is this a residential or commercial project? ❑ Residential V 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 E4 Other (explain)IYi\
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you may need to contact HistoncPreseruation
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.
of work
SS
'If lawn sprinkler/bacldlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty 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: C
Print Name: l2%rV /—nib{ Signature Date 47 L