HomeMy WebLinkAbout473 DENNISON AVE - APPLICATIONS - 8/6/2014Planning, Development & Transportation
Ci111ty�. of 281 N. College Ave P.O. Box 580
` Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY111.15
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 Date
For office use only
Job Site Address (required)
/
Value of Construction (labor, materials, profit)
J
j
l r
Property. Owner Name
fpowJ3n�e-
Address
City/State
Zip
Phone
Applicant Namw
Address City/State
W aG+} L
Zip
5�:6
Phone
9r-tu_53406a5
Contractor
Addr s
"fro ! ro G/
City/State IZip
G track_`
Phone
Contractor City of Ft. Collins Sales Tax # .
Sales tax number isrequirLod byall contactors
Are you paying with your trust account?
❑ Yes `No
Is this a residential or c mmercial project? OUtesidendal ❑ Commercial
If residential, is it: IX 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 I9"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 subm/t with this application.
Description of work
*If lawn sprinkler/ba& low 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 r 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: ) '��, /' 9�3-6-/
Print Name: '� l i '�ci9 Signature Date