HomeMy WebLinkAbout615 MATHEWS ST - APPLICATIONS - 10/17/2017From
10/17/2017 03:52 #773 P.001/002
FCity of Planning, Development, & Transportation Services
ort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.4162740 Fax: 970.224.6134
.14 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
EXHeating 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 #� 11 v1V 6�
For ofte use only
Date tJ a 1:-I� "`'I
lob Site Address (required) Value of Construction (labor, materials, profit)
r 6
Property Owner Name Address City/State Zip Phone
ApplicA Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft. Col ins Sales Tax # Are you paying taxes here or by report? $here ❑ Report
saes tax number isr qumdbyaarontracton. Are you paying with your trust account? fifes ❑ No
3S�s
Is this a residential or commercial project? -iiesidential ❑ Commercial
If residential, is It: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar O Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes O No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gly of At 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 wnstruction. I know that a
permit is not valid until it has been paid and issued.
Applicant:
Print Name: awmxt.. Signature �gq�, � `f*n� Date
Revision dsU VW]017
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