HomeMy WebLinkAbout423 BUCKEYE ST - APPLICATIONS - 1/6/2015Planning, Development & Transportation
City, of 281 N. College Ave P.O. Box 580
F®r ` Collins 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 ❑ 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 # T=� l SDOOSZ . Date G �S-
For office use only
lob Site Address (required)
Y-o S,;kq Value of Construction (labor, materials, profit)
1
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Property Owner Name Address
City/State Zip Phone
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13 vC,16 6 Y� 16rcocc,,..s Y-05--l-q TV-al`f-, 5-7
Applicant Name . Address
City/State Zip Phone
'SD N 09AL Qil M rvoL I SE FVty COCt 1 -5 q70 —337—
Contractor Address
City/State Zip Phone
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i_ L C s 432- L!— S 422 L.'
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? 0,Residential ❑ Commercial
If residential, is it: I(Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) IRGarage
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? 117A-
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work U P C:> nAQ6 5 v b - PA+✓67- rs/LiNI-- L-7Z.;, fi ac& rs vf
NCX_ �DlLI_ &DrrvL— a c.%ec.u,7s V Div Phmw,L.
*If lawn sprinkler/backnow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the comp any name or City of Ft Collins license #
YOP IC aCt-JV %L1+- s&%Acts
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:
Print Name: _ hL' %/ YoNk- Signature
Date
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