HomeMy WebLinkAbout925 COLUMBIA RD - APPLICATIONS - 6/21/2016JUN/21/20 WTUE 10:35 AM FAX No. P.002/004
City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
6rt Colti s 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�p Lawn Sprinkler I-] Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo-voitaic
❑ 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 # Bi LO v �ADVa Date % �� up ,
For office use only
Job Site Address (mquired) Value of Construction (labor, materials, profit)
Cad 00502 g,
Property Owner Name Address city/state zip Phone
J6,11i-,s Gfrurys A5 a `t1Q
�.. 1'1
Applicant Name Address City/State ZIP Phone
01,14 5nawu at 10U) �• 2"'o
Contractor Address City/State Zip Phone
&'aa'. L&DG int N Ar. $S20&
Contractor City of Ft: Collins Sales Tax # Are you paying taxes here or by report? Here ❑ Report
Sales tax VeW by all contactors Are you paying wit your trust account? I(Yes ❑ No
Is this a residential or commercial project? 16 Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: 0 Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explairyyr)
Is this building 50 years of age or more? ❑ Yes 0i'No If yes, you may need to contact HislnricPreservatlon
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 witty this application.
Description of work
*If lawn sprinkler/backfiow 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 rQ`
Electrician Plumber Mechanlcai_ Roofer Dther
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: �J 1 Signature �%�' paw �� �[