HomeMy WebLinkAbout625 ARMSTRONG AVE - APPLICATIONS - 10/28/2014P.lanninyi Development Sa Transportation
City of ` 281 N. College Ave P.O. Box 580
Fort CoLli ns. , Fort Collins, CO 80524
�.._ . Phone 970-416-2740 Fax 224-6134
OVER-THE®COUNTER PERMITS ONLY
This application is to be.used.fo apPiy,f�i the following permits only (check 1. ail
-that apply). . El Air Conditioning
❑ Demolition (interiorAcri-structural), ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ 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 # 01 I S Date
For otirce use only
Job Site Address ( uited)
Value c" O :,fir, materials, profit)
perty Owner N rie,•:`: ,. : ;'.,: Address
Gl ✓I-S.�P�J�
City/State ZID Phone G%
co
f h liY'
2Glt1
Applic nt Name Address City/State Zi Pha e
Contractor Address
"City/State'. Zip Phone
CD.�S�
Contractor City of -Ft: Collins -Sales Tax,# .
Are you paying taxes here or -by report? ❑ Here ❑ Report
sales taxnumberi quiedbyaffcoatractors.
Are you paying with your trust account?. ❑ Yes ❑ No
Is this a residential or commercial project? residential ❑ Commercial
If residential, is it:. Q Single.Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamify (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office"❑ Office • ❑ Retail
El Restaurant ❑ Other (explain),
Is this building 50 years of age or more? Q Yes ❑ No If yes, you mayneed to contact Historic Preservation
If this is for a.demoliti*permit, what year -was the bvilding constNcted?
If prior to I92s, you u�il%peed an'asbestos assessment to submit tvith this application-
Description of work._
*If lawn sprinkler/backfioW "p'reventet, must list licensed plumber. If first-time A/c, most list licensed electrician.
Subcontractors: (ist the cpmpaoyna,rye, or r:ity orptCollins license
Electrician Plumber MechanicalRoofer 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 or'dinarice's and state laws regulating building construction. I know that a
permit is notyalid until' it has been paid and issued.
Applicant: /*'-- � y, /- . �I/ / 1
Print Name. C..-� � �('c- `�/ L Zj Signatu Date / _ / /