HomeMy WebLinkAbout410 N COLLEGE AVE - APPLICATIONS - 2/9/2018City of Planning, Development, & Transportation Services
6 t � 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 23y
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 informationonthe application. Incomplete applications will not be accepted 11
Application # NUIOCI V� Date _q — I
For office use only 2,00
Job Site Address (required) Value of Construction (labor, materials, profit)
"-D N.C,61 Arc LiS1 /S
Property Owner Name Address City/State Zip Phone97 )17
U cR ' nn, Lit 13 o / Ca`- • L s2 (1123 -
Applicant Name ` ^ - Address City/State Zip Phone
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Contractor Address 1-20 1310R City/State Zip 7 done
i,) L 271 D 1 (7 KZ lz) -2ua to
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? -B"rre ❑ Report
5alestax number Isrequvedbyall contractors Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residenbal 8-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? ❑ Yesj2'No If yes, you may need to contact Histonc Presenobon
If this is for a demolition permit, what year was the building constructed?
Description of
work 2 ) 5 (C- S 1- - +J 5� ( A)C
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*If lawn sprinkler/backflowjpreventer, must list licensed plumber If first-time A/C, must list licensed electrician.
Subcontractors: List the companyname 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: Print Name•�I) Signature
2. �J
Date / 0
Rev,mon date 2/6/2017