HomeMy WebLinkAbout1320 SALEM ST - APPLICATIONS - 10/20/2014Ciof
Fort 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
O Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 'Roofing ❑ 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 # cb 14 10a9,?-
For office use only
Date 10, rX . i`t 1'��✓
Job Site Address (required)
Value of Construction (labor, materials, profit)
1370 SAt'-rm %- - Fn,f CollrNS
C'd P0rr—C. 70 - t _ oZ o
perry Owner Name Address
City/State Zip Phone
Pr b
Applicant Name Address
City/State Zip Phone
7 - 7 3- s7
Contractor Address
City/State Zip Phone
6I In al-'az-, ^ c
S• wi eU
Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes .27'fVo
Is this a residential or commercial project? )KResidential ❑ Commercial
If residential, is it: ,KSingle 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 ❑ 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 '�c-
*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 #
Mechanical Roofer ff/fk fez Other
Electrician Plumber
I hereby acknowledge that I have read this application and state that the above information is complete and correct. 1 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: Ah&mVet—) Signature
Date /0 - Z0 - / c/
y
/y