HomeMy WebLinkAbout6215 CARMICHAEL ST - APPLICATIONS - 8/31/2016AUG/31/2016/WED 03:35 Ply FAX No, P,007
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FCity of
lirt Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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 lF�Nater Heater Cl 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 # �J 105 pate
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
9-0529 1 1 2S14. 2 '
Property Owner Name Address City/state ZIP Phone
AADInava..Pill — Ir- wq p
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax #
Sales tax number I's-1equired by all contractvrs
Are you paying taxes here or by report? ❑ Here 0 Report
Are you paying with your trust account? 0 Yes ❑ No
Is this a residential or commercial project? Vilesidential ❑ 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 (explai�n
Is this building So years of ago or more? ❑ Yes I.YNo If yes, you may need to contact Historic Preservation
If this is for a demolition, permit, what year was the building constructed?'
Ifprlor ta,1975, you w/l/need an asbestos assessment to submit with this application,
Description, of work
*If lawn sprinkler/backnow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or aty of Ft Collins liciense of
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 requiremenmeomtained 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: --)�,,r�
_W Signature
Date