HomeMy WebLinkAbout1320 ALFORD ST - APPLICATIONS - 4/16/2012City of
F®rt CoWns
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Planning, Developmmmt & 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 # Q0 ( Date q idb
For ofFrco use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
,h
Property Owner Name
Address
City/State Zip
Phone
Applicant Name
Address
City/State Zip
Phone
.
t J,j' i c'C,•
ConbBCbDr
Address
City/State Zip
Phone
ConbwWr City of FL Collins Sales Tax #
Are you paying taxes here or by report?
q Here ❑ Report
Saks 1arnmm6a6rapukedbya#cvnbactors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? O Residential ❑ Commercial
If residential, isit OSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (aparhnent) ❑ 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 m�;wlic presarwaon
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, ynu wi# need an asbestos assess nentto submit with this app/ica*on.
Description of work �� =t' s 'F+¢' > �!/ �: et
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*If lawn sprinkler/baddiow preve►ter, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: t tst the company name or Gly of FtCo/rtieshbw-e #
Bemician Plumber Medianical Roofer - Other
I heathy 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 slate laws regulating building construction. I know that a
permit is not valid until it has been paid and issi
Applicant -ter i
Print Name: Signature ___._ Date