HomeMy WebLinkAbout418 LINDEN ST - APPLICATIONS - 5/19/2017F®rt Collins
of
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 ❑ 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 # /13 ,/ 0 Date Ell'?
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For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name
Address
City/State
Zip
Phone
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Applicant Name
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City/State
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Zip
Phone
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Contractor Uc #
Address
City/State
Zip
Phone
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Contractor City of Ft. Collins Sales Tax #
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Are you paying taxes here or by report? ❑ Here 13 Report
'Was tax number ismquihedbyall contractors.
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential a 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) j°-4*�t A�
Is this building 50 years of age or more? ❑ Yes P No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work - 1�e73 ;0,4.a
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must 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: % L� _
Print Name:�OJt' % (` �O eT Signature ! /- Date ��