HomeMy WebLinkAbout4112 TANAGER ST - APPLICATIONS - 8/18/2014To: City of Fort Collins Page 2 of 2 2014-08-18 20:01:15 (GMT) From: KUDZU Companies
Planning, Development & Transportation
1 #O#f 281 N. College Ave P.O. Box 580
-:#. � oLli1M s: 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 lthe application. Incomplete applications will not be accepted.
Application # 1 b �` ' Date.
for office use only
Job Site Address &nwdred)
Value of Construction (labor, materials, profit)
, 4 M.
Property Owner Name Address
City/State' Zip Phone
wry- U)00L cog -a
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Applicant Name Address
City/State Zip Phone
1y1 �r
'
Contractor Address
qty/State Zip Phone
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report? A(Here ❑ Report
Saks tax number byal/ wnbactors.
Are you paying with your trust account? ❑ Yes ❑ No
Is. this a.residenbal:oreo merciai project.? Residential [].Commercial.
If residential, is ct. 05ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Dkiplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other jexp. )
Is this building 50 years of age or mpre? yes, you may need to contact Histonc Preservation
If this is for a demolition permit, what ..year was the building constructed?
Ypnor to 1975, you wl/l need an asbestos assessment to submit Wth this apiolkatron.
of
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractor;: List the company name or City of Ft Collins license #
Electridan K' Number 1`: R ftechanTca{ _^ fl A Roofer
14 •A Other NIPr
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: Q—- Signature