HomeMy WebLinkAbout624 SMITH ST - APPLICATIONS - 2/2/2015Fort Collins
Planning, Development &Transportation
281 N. College Ave P.O. Box 580
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 ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 0JWater 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 # b\) 5�0` Date ;z v-
Fbr 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 i190
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Applicant Name
Address 3/a 9 City/State Zip ?052YPhone 9?o
Contractor
Address City/State Zip
Phone
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Contractor City of Ft. Collins gales Tax # Are you paying taxes here or by report?
❑ Here ❑ Report
sales lax number Is required by all contractors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project?
If residential, is it: 0,5ingle Family Detac e
❑ Multifamily (apartment)
sidential - ❑ Commercial
❑ Condo/townhome (single family attached) ❑ Duplex
❑ 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? 4 Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year as the building constructed?
Ifjonor to 1975, you will 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 #
Electrician Plumber Mechanical H-9-- 00,6 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: t c / Z // 9 �I/ 4
Print Name: �%t-f� .� l�l �iSi nature �� ��` Date /` Z �