HomeMy WebLinkAbout940 PIONEER AVE - APPLICATIONS - 1/18/2018vvcllr���nc-vvve��l`r� rc��■�■■■v veer■
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 Xwater Heater ❑ Water Line ❑ WoodlPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # ice' o oc 3 q4 Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
P perty Owner Name
Address
City/State Zip
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Phone
pplicant N me
Address
Ci /State Zip
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Address
Ci�c/State Zip
Phone
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Contractor City of Ft. Collins Sales x #
Are you paying taxes here or by report?
❑ Here OReport
5alestax number isrequired bya!/contractors
3Lce:2
Are you paying with your trust account?,9 Yes ❑ No
Is this a residential or co mercial project? 0 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 more? ❑ Yes )dNo if yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
if prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed'electridan.
Subcontractors: List the company name or City of Ft Collins license #
Electrician plumber tAp o 3 BI 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:
Print Name: \ Signature Date 1, 6 r LG I'i8