HomeMy WebLinkAbout1418 SIOUX BLVD - APPLICATIONS - 5/11/2017Planning, Development, & Transportation Services
_ FOrt-colllns Community Development & Neighborhood Services
281 North College Avenue
Fort Collins CO 80524 Alain 970 416 2740 Fax 970 224 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
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Application # Date
For o ice us on
)ob Site Address (required) Value of Construction (labor, matenals, profit)
Ia' 7 i 4 --If too CO
Property Owner Name Address City/Sta a ZIP Phone
Applicant Name Address Cityff/Stat Zip Phone
Conti or Address City/State Zip Phone
/one_4vto 1— C al ,crt 05 70 77 SX
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? ❑ Here IN Report
sal, lax number is requzred>a�l mnbactors Are you paying with your trust account? ❑ Yes ® No
eG� -s
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 morel ❑ Yes ❑ No If yes, you may need to contact Histonc Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work a �4 (e 4c, K- c_
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*If lawn sprinkler/backfiow preventer, must list licensed plumber If first-time A/C, must list licensed electrician
Subcontractors List the company name or Gly of Ft Collins license #
Electnoan Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above informabon is complete and correct I agree to
comply with all requirements contained herein and city ordinances and state laws regulating budding construction I know that a
permit is not valid until it has been paid and issued
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Applicant 4Z-DatePrint Name —1+'' /ou/ I Signature 5 XI ul7
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Reovon dace 2/62017