HomeMy WebLinkAbout605 BIRKY PL - APPLICATIONS - 5/4/2012r'-1Q g35
City of Planning, Development &.Transportation
281 N. College Ave P.O. Box 580
�
�t 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 # F 1 a() u c�
For ofce use only
Date 5-/-/- P7/G
Job Site Address (required)
Value of Construction (labor, materials, profit)
1005 tr kP1.
seq(oo ' 00
Property Owner Name Address
City/State Zip
Phone
_/Give?. S r
1. Eipyt Colliels F0526 39 - 7
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
�/ ZZO
1 'Imsas
"/ -ao2G - 86 1
Contractor City of 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 No
Is this a residential or commercial project? A Residential ❑ Commercial
If residential, is it: 'la 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 Ifyes, you may need to contact Historic Preservation
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.
Description of work I nS4- 0,1 l l lam` r
*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: /� ` ( 1 /l
Print Name:t iM 8 UUVt"�"C O Ir ct Signature Date