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HomeMy WebLinkAbout629 LESSER DR - APPLICATIONS - 4/24/2012r Fort 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 # �h) 'Z 0 E3`Z)q - Date �-2Y - / 2- For office use only 1 I —) � Job Site Address (required) I Value of Construction (labor, materials, profit) � � 24,2 s ce, o Qj Cn $ I3 C' Property Owner Name Address City/State Zip Phone /��Q�Gilta /� �ir...✓ s.>...._ as anon F YCi - 3/i�. Applicant Name Address City/State Zip Phone Contractor Lic # Address City/State Zip Phone S''ox(eroN Qoo S-1014 N .C2-3 cm %osz" Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here MReport sales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes ❑ No Is this a residential or commercial project? 6!5 Residential ❑ Commercial If residential, is it: 0 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 (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? If pnor to 1975, you will need an asbestos assessment to submit with this application. Description of work 4-P �� rNsell ©C- sHp �.� 2 �v,a set. *If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed 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 building construction. I know that a permit is not valid until it has been paid and issued. Applicant: * 6A�� Print Name: (4Signature Date Cf-2`?-( L