HomeMy WebLinkAbout639 S COLLEGE AVE - APPLICATIONS - 1/19/2015City Of Planning, Development & Transportation
For
FbIl ` Collins N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-41616-2740 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
[A 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 # 1�>IM051_0S.
For offIce use only
Date 1-19-15
Job Site Address (required)
Value of Construction (labor, materials, profit)
639 S. College Ave., Fort Collins, CO 80524
$20,000
Property Owner Name Address
City/State Zip
Phone
South College 639, LLC 262 E. Mountain
Ave. Fort Collins, CO 80524
970-221-2636
Applicant Name Address
City/State Zip
Phone
The Neenan Company 2607 Midpoint
Dr. Fort Collins, CO 80525
970-493-8747
Contractor Address
City/State Zip
Phone
The Neenan Company 2607 Midpoint
Dr. Fort Collins, CO 80525
970-493-8747
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
EIN: 84-1590338
Is this a residential or commercial project? ❑ Residential C4 Commercial
If residential, is it: ❑ 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 X Other (explain) Music District
Is this building 50 years of age or more? 0 Yes ❑ No If yes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? 1910
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work R+ A4ayM_ cf` 5k-T-mok (AA*ttSl 1Arr&uyk wAccsl VSE 65:� ,tnfatf7� Tit'.
S�tf2Wa. MISC SITS F_U�I�bN'�
*If lawn sprinkler/backflow 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 #
Poudre Valley Air of
Electrician Gregory Electric, Inc. Plumber Corporate Plumbing, Inc. Mechanical Northern Colorado, Inc -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: Sergio Ortiz Signature
Date 1-19-15