HomeMy WebLinkAbout414 MAPLE ST - APPLICATIONS - 6/10/2012Cityof Planning, Development & Transportation
281 N. College Ave P.O. Box 580
! 6rl,} Collins 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
❑ K 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 appli ation will not be accepted.
Application # -� �5C�5 Date ,6 0 1�—
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name
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Address City/State
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Zip
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Phone
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Applicant Name
Address City/State
Zip
Phone
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Contractor Lic #
Address City/State
Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? ;9
If residential, is it: ❑ Single Family Detached
❑ Multifamily (apartment)
Residential ❑ Commercial
❑ Condo/townhome (single family attached) ❑ Duplex
JZ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building SO years of age or more? ,)d 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
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*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 #
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: VfXVW J ail S i �U (�/l 1 l
Print Name: / Signature Date