HomeMy WebLinkAbout600 LOCUST GROVE DR - APPLICATIONS - 5/7/2012City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins Fort Collins, CO 80524
`. Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY I�
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 I LWater Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application.
Application # �� 2—(OP5
For office use only
Job Site Address (required)
7L
Incomplete applications will not be accepted.
Date :51-7 /a o 1..2
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State
Zip
Phone
rhokrk Lbsof^ (000 Loc.us4—U.ow� �- radios
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303--(,o)-(Ow,
Applicant Name Address
City/State
Zip
Phone
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Contractor Lic # Address
City/State
Zip
Phone
L r ,- .
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: [&Single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Restaurant ❑ Other (explain)
❑ Duplex
01. f_-
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 prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work `Jea/ uJ
*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 4c34-4%. -P 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:
Print Name: J T
Date S-171,)dZ