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HomeMy WebLinkAbout1320 PATTON ST - APPLICATIONS - 3/20/2015Resend03-30-15;08:05AM; ;970-484-4448 # 5/ 10 F-6c,FEY. or 281 N. College Ave P.Q. Box 580 --r� Coltin5 Fort Collins, 00 80524 Phone 97D-416-2740 Fax 224-6134 OVER-THE-COUNTER -PERMITS ONLY This application is to be used to apply for the following perihIts only,(check all that apply). 0 Air Conditioning ❑ Demolition (Interior non-structural) 17 Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log Q Heating Unit 17 Lawn Sprinkler ❑ Mobile Home replacement O Roofing ❑ Sewer Line ❑ Photo-voitaic 0 Ventilation Water Heater 0 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 # Z115D70��-- Date For office use only Job Site Address (requlre(f s. Value of Construction (labor, materials, profit) 13 0ao Address Q Propertyer ame Zip �V New ry/�� iIJ Phone nn 4ennrm ackson 1 Applicant Nam Address L1!u Gty/State Zip Phone 174• g • 11AW . 1?05 ntractor Address e r to i& i City/State ZIP ('.� $0Aa Phone Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Here epart serereaxnurn6er1 �� �byallconbJeMrs Are you paying with your trust account? Yes No Is this a residential or commercial protect? 3itesldential ❑Commercial If residential, is it: Single Family Detacifed- ❑ Condo/townhome (single family attached) © Duplex ❑ Multifamlly (apartment) 0 Garage Ifcommercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office E3 Office ❑ Retall ❑ Restaurant E3 Other (explain) Is this building 50 years of age or more? ❑ Yes ❑ No Pfyes, you may need to cont9ctH1sinr1cT1vssrva6'on If this is for a demolition'perinit, what year was the building constructed? lfpn'orto fY75 you coil/need an asba&S assessment to submlt w6 fhls app/iCUGon. Description of work *If lawn sprinkler/backftow preventer; must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: ustthe companynameOrA'1yofRCollIns1XM8# Electridan 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. Applicant: ' Print Name: rI n 4 Date 3- aa--i6'