HomeMy WebLinkAbout825 PEAR ST - APPLICATIONS - 3/5/2015Planning, Development & Transportation
City Of 281 N. College Ave P.O. Box 580
!61 t 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
❑ Heating Unit ❑ Lawn Sprinkler El Mobile Home replacement El Roofing El 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
For office use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip
Phone
Applicant Name Address
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City/State Zip
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Phone
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Contractor Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by all contractors
Are you paying taxes here or by report? Here
Are you paying with your trust account? ❑ Yes
❑ Report
❑ No
Is this a residential or commercial project? %Residential ❑ Commercial
If residential, is it: M Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ANo 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 w111 need an asbestos assessment to submit with this application.
Description of work
*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 #
ElectricianraeR(5DA EIe61"iLPlumber 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. n n n n
Applicant: ��)—" �C1. n �i lYd Jl /! �/ /U �V ` ��
Print Name: �t\1 a 1r50 Signature , Date
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