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HomeMy WebLinkAbout672 JUSTICE DR - APPLICATIONS - 9/29/2014Sep 29 14 07:06p O � \L4\ Fort Collins ,a - t p�� p.1 /Y7�1Q5��-�C � . Ct7rr1 Planning, Development &Transportation 281 N. College Ave P.O. Box 580 Fort Collins, Co 10524 Phone 970-416-27 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 17 Ventilation ❑ Water Heater 17 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 #'g I q I GZQu Date C o?C`% I y For office use only Job Site Address (mquired) Value of Construction (labor, materials, profit) 12y-* $21-160 Property Owner Name Address City/State Zip &�6-Z(p Phone ai C 1 G Applicant Name C�Address 'istate i iz 1 <N Zip 9GIC�7 Phone Contractor Address ly7gO LC'1Y1kvie ate � L iZ A6t t-k Zip Phone 3 } L)S n��i;)G—L2 Pa, i�t ►Z32 S L `� cc) . iU Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report Sales tarnumbarisregulred by all contractors. Are you paying with your trust account? f,Ves ❑ No Is this a residential or corpmercial project? DrResidential ❑ Commercial If residential, is it: ngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, is it: ❑ Sank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office © office ❑ Retail ❑ Restaurant E3 Other (explain) Is this building 50 years of age or more? ❑ Yes to Ifyes, you may need to contact Historic Preservation If this Is far a demolition permit, what year was the building constructed? Ifpnor to 1975, you will need an asbestos assessment to submit with thisaq*ation. Of *If lawn sprinkleriback low preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: List the cvmpanyname orCrty of Ft Collins license # Eiedridan 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 Date 9.141 Um �I1�7