HomeMy WebLinkAbout4700 MCMURRY AVE - APPLICATIONS - 3/16/2015C
'City Planning, Development & Transportation
of 281 N. College Ave P.O. Box 580
Fart CoWns Fort Collins, CO 80524
l- Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY ✓� y
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 El Sewer Line ❑ Photo -voltaic
❑ Ventilation El Water Heater 1-1WaterLine ElWood/Pellet S ve (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete appli ations will not be accepted.
Application # 61501 � /(0
For office use only
Date ��6 (�
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
Addresssnor
Zip `/'') Phone /
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Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? Here ❑ Report
S. taxnnurpberrisrequired byall contractors.
Are you paying with your trust account? El Yes ❑ 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 4 Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building So years of age or more? []Yes )S 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 Jl- 'F` (-t- 15- 7 � D or�
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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 City 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.
Applican RICHARD M. COHEN, PRESIDENT 4z�-�
�OLORADO MOISTURE CONTROL, INC.: t 3
Print Name: signatureDate
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