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HomeMy WebLinkAbout636 FOXTAIL ST - APPLICATIONS - 2/1/2016(Planning, Development & Transportation �ity ©� 281 N. College Ave P.O. Box 580 �� � ��� �' - )'u 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 ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation `p 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 # For office use only Date 2 ' ( , I(--' Sob Site Address (required) Value of Construction (labor, materials, profit) lO 5(1 P_1)1_�fCl- I I S'r. fi I , -I--) I "-� Property Owner Name Addresss City/Stated Zip lb 06-D Phone( ` -70 Applicant Name Address City/State Zip Phone { 31 /_ 7 l�i'1J•.{_,L�L-rLG�... L�=� CJ�J `%��J ��l _J l J J Contractor Address City/State Zip 00 5'3] Phone ci -i0 �,vl�,l�i�-i-.�. `��.ii�..�l..V. 1. � �{.li bl: �)1 11.'�,/' LI' � J �- .t.:Yi �^�,y�-vL',k.. I.�i: �.j � �.�'t;.� G•1 C.,^.'j J 4 7 iI 1 Contractor City of Ft. Collins Sales Tax # ` Are you paying taxes here or by report? Here ❑ Report Sales tax number is required by a#contractors Are you paying with your trust account? p'Yes ❑ No _ -5 .� :5 -7 Is this a residential or commercial project? PResidential ❑ Commercial If residential, is it: USingle 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 SO years of age or more? ❑ Yes ❑ No 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 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. % know that a permit is not valid until it has been paid and issued. Applicant: Print name: I i �i �'� Signature 1��.� % �:� 1Li (JCL;- Date _ L