HomeMy WebLinkAbout609 DUKE LN - APPLICATIONS - 11/30/2017City 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 appfor'the following permits only (check all that apply). ❑Air Conditioning
❑ Demolition (interior non-structural) lectrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ obile 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 # b'/70 p lc
For office use only
Date
Job Site Address (required) Value of Construction (labor, materials, profit)
O i4C/ "91.� I z�. o0
Property Owner Name Address City/State Zip Phone
F �t r u V-6 CC, CU 6p5Z5J�3
Applicant Nam Address City/State Zip Phone
Contractor Address City/State Zip Phone
CLEA4JE.rr_ c— ( Co eo5Z z
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by all contractors Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or co_gmercial project?— esidential ❑ 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 ❑ 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
*If lawn sprinkler/backtiow preventer, must list licensed plumber If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Coffins bcense #
Electrician, f�C2'1�! ( Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this applicabon 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/ / y
Print Name:B{6W 1��� Signature to
Revimon date 2B2017 ("I'll
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