HomeMy WebLinkAbout328 W MOUNTAIN AVE - APPLICATIONS - 4/4/2012City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
FQrt 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 ❑ 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 # 11-0 OA9,t, Date %4 - 44 - :2 01�
For offlce use only
Job Site Address' (required) II Value of
Construction (labor, materials, profit)
8 Ij. (Mak'kLI✓t G(J` � CQ $ qsJ 000 - 00
Property Owner Name Address
City/State Zip
Phone
G`vy- of Try �acl�ws Soo
1-a Aft Qve. �oAcot/ u-e a gmai
q70 231-W33
Applicant Name Address
City/State Zip
Phone
ru c 2_ rvuL_ 300 CO -SbSa2 1 SG 6 -`?o K5—
Contractor Lic # Address
City/State Zip
Phone
Contractor City o Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account?
❑ Yes E"6
Is this a residential or comercial project? ►Q Residential ❑ Commercial
If residential, is it: co
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 ❑ Otpr (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? 1 610 G - mar• rr M cAA.A I I i 0- WtS wA3
If prior to 1975, you will need an asbestos assessment to submit with this application. <-` `~ e
Description of work
wu.i, � lass 12
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electri6aA.
Subcontractors: List the company name or City of Ft Collins license l e r
Electrician Plumber Mechanical Roofer eu-&4"cK 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: r' ���
Print Name: �r Signature
Date q — 14 " zo i a-