HomeMy WebLinkAbout6001 S COLLEGE AVE - APPLICATIONS - 3/12/2015City Of Planning, Development &Transportation
Fort Collins 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 se is change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement oofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove st be EPA certified,' provide make, model and
manufacturer).
Complete.all applicable information on the application. Incomplete applications will not be accepted.
Application # F15015?iI Date 3- /a s
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name
j4K Address
City/State Zip
Phone
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Ca.�o aS
Applicant Name
Address
City/State Zip
r _ Phone
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Contractor
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 eK No
Is this a residential or commercial project? ❑ Residential '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 ❑ Retail
restaurant ❑ Other (explain) /.%u l/Ur1zX_S
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 will need an asbestos assessment to submit with this application.
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*If lawn sprinkler/backflow preventer, must list licensed plbmber. If first-time A/C, must list licensed electrician. P'\lN L-�
Subcontractors: List the company name or City of FtC01tinslicense # HA(^-TTIaAN
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.
Applicants n J
Print Name: ae-v h r-e4iGA Signature �[ Date - �a' / S