HomeMy WebLinkAbout625 STOVER ST - APPLICATIONS - 5/14/2012Fort 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
nr the application. Incomplete applicatio s w' I not be accepted.
Application # 2 t - ►lt' Date /Z-
For office use only I
Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
C v-4 a11ow (0Zs .Sjyv.
City/State Zip
r�(,ol& Ta z
Phone
97o 2Zr 2
Applicant Name Address
%% CityState Zip
Phone
Contractor LLi!ic # Address
/State Zip
Phone
Con actor City of Ft. Collins Sales Tax #
Sales tax number isrequiredbyall contractors.
Are you paying taxes here or by report? ere ❑ Aeport
Are you paying with your trust account? ❑ Yes o
Is this a residential or c mmercial project? 66- residential ❑ Commercial
If residential, is it: ingle 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--95`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.
of work
*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 #
Electridan 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. 717
Applicant:
Print Name: �L Wr Signature
Date