HomeMy WebLinkAbout430 GUILLEMONT ST - APPLICATIONS - 9/9/20149/9/2014 2:43 PM FROM: 9702081701
TO: 9702246134 P
of
Flirt Collins
Planning, Development IN Transportatkm
281 N. College Ave P.O. Box 58o
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVERm TH&COUNTER PERMS ONLY
This application Is to be used to apply for the following p®tntits only (check all that apply), ❑ Air Conditioning
0 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log
❑ Heating Unit M Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing 0 Sewer Line 0 Photo -voltaic
0 Ventilation Cl Water Heater ❑ Water Line 0 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 # F�B Date _ ICJ 1,4
For ofte use only
Sob Site Address (required) Value of (labor, materials, profit)
LAJ
Property Owner Name Address CiNState Zip Phone
Applicant flame Address City/State Zip phone
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Contractor Address City/state Zip calorie
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?.>Etliere ❑ Report
-Wa9 tar n4yrl&r u AVur"red by atr ca*acMm Are you Paying with your trtat aocwmt?des O No
Is this a residential or commercial project? _04fesideritial ❑ Commercial
If residential, is It: P4ingle Family DeWched O Condo/townhome (single family attached) 0 Duplex
Multifamily (apartrnent) ❑ Garage
If commercial, is it: ❑ Bank p Bar 0 Church ❑ /Motel ❑ Medical office ❑ Office Cl Retail
13 Restaurant 0 Other (explain)
Is this building 50 years of age or more? E3 Yes Ifine You may need tact H/stor/e Pls?s. b;oa
If this is for a denwAition permit, what year was the okAng constructed?
If prior to 1975, yw wl// need an asbestos amezrra7t to submit with this aAolkat m.
Description of work
*If lawn sprinkler/bacidiow preventer, must list licensed plumber. If first-time A/ , must list licensed eiechi an.
Subcontractors: Gist dire cvmpany name or GW Off ? Coll/t S /a27se #
Electrician PIWTd er t4e� Roofer 2 j� Ottler
I hereby aduwwledge that I have read this application and state that the above information Is complete and oxrect. I agree to
comply with all requirements contained herein and city ordinances and state taws regulating building crostruction. I know that a
perntit Is not valid until It has been paid and ! sited.
AppnCBM:
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