HomeMy WebLinkAbout825 SMITH ST - APPLICATIONS - 6/1/2015City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
®�t 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 # `g Sd `1 DDate �o
For offlce use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
62S SmIkVi
*1500C, 00
Property Owner Name Address
City/State Zip
Phone
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Ap licant Name ki Address
Citv/State Zip
Phone
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Oenve-1 Co. SOZ02
Contractor Ad ess
City/State Zip
Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes h re or by report?
❑ Here ❑ Report
Sales tax number Is, requ/red by allwntractois
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or mmercial project? Residential ❑ Commercial
If residential, is it: Single Family DetachI d ❑ 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?
Ypnor to 1975, you will need an asbestos assessment to submit with this application.
*If lawn sprinkler/bacldlow 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 #
Electddan 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: L,f �s�5f? Signature Date 0 b 10116