HomeMy WebLinkAbout1418 SALEM ST - APPLICATIONS - 1/7/2015City 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' XRoofing ❑ 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 #� 5 Date
For office use on/v
Sob Site Address (required)
Sa,
Value of Construction (labor, materials, profit)
29&40'
Property Owner Name
Address
City/State Zip Phone
FC led SZS -z�s-37S7
,Om
Applicant Name
Address
7203
City/State Zip Phone
7 7'/-
Contractor
Address
City/State Zip Phone 99D
C'd d. V(h
S. CR
27 BS ou
Y
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?? Here ❑ Report
Are; you paying with your trust accoun .>
Sales fax number is required by all contractors.
Is this a residential or commercial project? Residential; ❑ 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 ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes )!CNo if yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
if prior to 1975, you will need an asbestos assessment to submit with this app/icdbon.
Description of
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician. gse-
Subcontractors: List the company name or City of Ft Collins license# G
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: Signature Date