HomeMy WebLinkAbout418 GUILLEMONT ST - APPLICATIONS - 9/29/2015panning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
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 )V 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 # :jj � id6P Date q7 Ze�(— 2dl;s S c�
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name
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Name
Address
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Zip
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or
by report? I *Here ❑ Report
Sales tax numberisrequired by all contractors.
Are you paying with your trust account? ❑ Yes PPNo
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 I�111\lo If yes, you may need to contact Historic Presentation
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 application.
Description of wo
*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: /` ) 67
Print Name: � llel i ll� Signature Date
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