HomeMy WebLinkAbout664 BREWER DR - APPLICATIONS - 6/9/2015 (2)FROM :NCR FAX NO. :9702299983 Jun. 03 2015 04:03PM P2/2
Planning, Development & Transportation
For N. College Ave P.O. Box 580
Fort Collins Fort e„ , ,� 1
Collins, CO 80524 � (� �"'
Phone 970.416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY US'
This application Is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
Femolition (Interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
eating Unit Lawn Sprinkler ❑ Mobile Home replacement i7 Roofing ❑ Sewer line ❑ Photo-volfale
entilation A Water Heater ❑ Water Line D 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 # _' v Date L•� u
For offcc use on/y
Sob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip
Phone
veu) # 'hv. �Z
Applicant Nam Address
City/State Zip
Phone
Contractor Address
City/State F+W11V1C.Zip
Phone Q1"'b
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y, Ale- co 4im Zvi'
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? JKfere
❑ Report
sales tax numaerisrequiredbya#contractarv.
Are you paying with your trust account? AtVes
❑ No
Is this a residential or cc merclal project? f�l''itesidential El Commercial
If residential, is it: 5ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar O Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes )2rNo 1f 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 subm/t with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or C/ty of Ft Collins lens #
Electrician Plumber — Meeilanlcal 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 Nam
Date -(o-3--A5...