HomeMy WebLinkAbout624 SMITH ST - APPLICATIONS - 9/23/2015Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
Zft
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 # Date0�3�/� a
For ohice use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
�,,,'k S
%375`=
Property Owner Name
Address 6a51
City/State / o Zip
Phone
Se- 41 6e se nz
S , ti S-f
Cd�/,ys Ca
5�o-vJ6
Applicant Name
Address ,2-02 l City/State%cve Zip T67539
Phone ft
��'//S %Airy v�✓
11
Ca
5oj0-6�
Contractor
Address
City/State Zip
Phone
A %� r✓ a� �. �C✓
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? A -Here
❑ Report
5alestax numberisrequired byall contractors.
Are you paying with your trust account? ❑ Yes
drt'- No
Is this a residential or commercial project? KResidential ❑ Commercial
If residential, is it:. f3 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
7f 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
rmit If this is for a demolition pe, what yea was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit 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 City of Ft Collins license #
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: //JJ�� 11 % c�
Print framer%—GW is /' Ae"_7JVSignature ' `�� Date ! 7