HomeMy WebLinkAbout636 PETERSON ST - APPLICATIONS - 11/7/2011Uty of rw000i�/ vc�civrli11C11{ a IIOIIaFUFW{Ipn
Fort Collins Fort Collins,, CO 80524.0. Box 580
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
1P 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 U\nNi%%
For office we only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip Phone
Applicant Name Address
City/StateZIP Phone
Contractor Address
Gty/State Zip Phone
kc
a!As Lk
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here 50 Report
Sales tax nurnberisnrgrdredbya#cnnbacims
Are you paying with your trust account? AfYes 13No
Is this a residential
If residential, is it:
If commercial, is it:
or commercial project? kollesidential ❑ Commercial
19) Single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes . ❑ No If yes, you may need to contact Historic preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will need an asbestos assessment to submit with this application.
Description of
" Ir lawn sprinkler/bacldlow 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 0
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: ^'
Print Name: ` LC& keknm Signature{„ � L h � Date
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