HomeMy WebLinkAbout143 N MCKINLEY AVE - APPLICATIONS - 5/12/2015Ciof
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
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement IX 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.
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Application #? _ Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name
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Address
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City/State Zip
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Phone C191)
Applicant Name
Address
City/State Zip
Phone
Contractor` '
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Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Sates tax number is required byaticontractors.
Are you paying taxes here or by report? ❑ Here
Are you paying with your trust account? ❑ Yes
❑ Report
❑ No
Is this a residential or commercial project? 0 Residential ❑ Commercial
If residential, is it: 10 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)
Is this building 50 years of age or more? ❑ Yes ❑ No ffyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
ff prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work* Z,;- 24_<05 0" :�;D �1�,rvalps
preventer, rhust list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license if
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.
Applicant:—�G���-- ` 2
Print Name: °� Signature Date _ i