HomeMy WebLinkAbout422 N GRANT AVE - APPLICATIONS - 6/16/2017City of Planning, Development, & Transportation Services
Fort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main 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 Informatiioojn on t e application.
Application # kr''f 0 / I
For office use only
Incomplete applications will not be accepted
Date Lo- I to— I J
Job Site Address (requlred) Value of Construction (labor, materials, profit)
ry U xy
Property Owner Name Address City/State Zip Phone
Applicard Name Address City/State Zip Phone
/ems 1�GuiZ ,�
Address City/State Zip Phone
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? Fri4ere ❑ Report
Sales fax number isrequ/redbyall cnnbacWm Are you paying with your trust account? ❑ Yes ❑ No
Is this a residenbal or commercial pmjed7 WResidentai ❑ Commercial
If residential, is it: J(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 JtYes ❑ No If yes, you may need to contact Hcstonc Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work Y01.5 A kl,!?f C,Qu i= I S'To
*If lawn spnnkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Cty of R Collins /rosose +sY
Ekxtnaan' Plumber Merhanrcal 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 construcbon. I know that a
permit is not valid until it has been paid and issued.
Applicant-
PrintName� / hrr!/�F�y/y/a Signature Date 4ZZ4LI7
11 le
RevWw date 2e2017