HomeMy WebLinkAbout639 S COLLEGE AVE - APPLICATIONS - 9/26/2014Planning, Development &Transportation
City of 281 N. College Ave P.O. Box 580
Fort CoWns Fort Collins, CO 80524
�.— Phone 970-416-c277(400 Fax
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24--6134
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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 9/Z���
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State
Zip
Phone
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Applicant Name Address
City/State
Zip
Phone
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Contractor Address
City/State
Zip
Phone
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Contractor City of Ft. Collins Sales Tax #
sales tax number is required by all contractors.
Are you paying with
your trust account?
❑ Yes a-1415-
Is this a residential or commercial project? ❑ Residential e'Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office 2- tail
❑ Restaurant ❑ Othe xplain)
Is this building 50 years of age or more? Yes ❑ 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 submit with this application.
Description of work
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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 CO 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: ', /;���,,,,,,,,,,.� (
Print Name: '�ti�y"'112 J Signature
Date �4
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