HomeMy WebLinkAbout654 CARRIAGE PKWY - APPLICATIONS - 7/21/2016City o� Planning, Development & Transportation
Fo�$ Collins 281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-41616-2740 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 ❑ 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 #
8lLeo j4a-0:5
For office use only
Date dz2 � /.I L1 / -1, a /
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Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip
Phone
T / 1 Sy
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Applicant Name Address
City/State Zip
Phone
11 .l 06 i 4Ci'f i So.
/
23 G I k k l F[ i!
Contractor Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
❑ Report
sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? D/Residential ❑ Commercial
If residential, is it: U'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 ID/No If yes, you may need to contact Historic Preservation
If this is for ademolition permit, what year was the building constructed?
Ifprior,to 1975, you will need an asbestos assessment to submit with this application.
Descri Rti o n of wo rk ik,4 - 0-ri /i e_ 0 Xd -b 4.P
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
I;
Subcontractors: List the company name or City of Ft Collins license #
Electrician I 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:
Print Name: l p4,_ i & iA � �Tne^m Signature (t �h.t dA a . C \5119 A-_41y\ Date 7
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