HomeMy WebLinkAbout603 QUAKING ASPEN DR - APPLICATIONS - 8/16/2016City of
Fort Collins
/111� -
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
0'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 # IMV-04130
For office use only
Date !g - 4 -16
Job Site Address (required)
Value of Construction (labor, materials, profit)
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loll 101 Io3 104 (os 16 I -7 1o8
Property Owner Name Address
City/State Zip
Phone
o vs Cq no AvEl4ffir4
CiIA11-Col4ittcCo ''OS.z
0170 -acl 7 - ?6
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
LUSK -s-row'fora cl767 L. gayma A y&. CL= P r- 1 c CO S012.
303.78q-4
Contractor Cityof Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax numb risrequiredbyallcontractors
�q I b 7
Are you paying with your trust account? ❑ Yes
❑ No
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 5aNo 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 �E�lv.� !'l Gbt�n� e..j-r of 1r4ric al4n. VV&1.LS 101GU0114- S'fi1nf Cor+cftcrrr
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*If lawn sprinkler/baickfiow:preventer, must list licensed plumber. If first-time A/C, mus 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: n_ -
PrintName:�y, HaVS(-� Signature'y, Date r1 -16