HomeMy WebLinkAbout1418 REDWOOD ST - APPLICATIONS - 9/11/2018City cY
fOr$ Collins Planning, Development, & Transportation Services
Q.� Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
OVER-THE-COUNTER PERMIT'S 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 El Water Line manufacturer). ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # & 8 q Date �� I� �j
For offce use only _
Job Site Address (required) Value of Construction (labor, materials, profit)
1-4
Prop Owner Name L G G
Address Gty/State Zip Phone
Applicant Name �" Addres1sT r City/State Zip Phone
kom'n1 bU�d 1 �C �%1. 1 V S+ lA
Contractor `t A 80 �D� Rio A0 uu 3
M��Q{�yV� �jyAt�gn Address City/State Zip Phone
INb -14 . �iR.eZl @ C.O. q,D foci 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 A No
Is this a residential or commercial project?
If residential, is it: Residential ❑Commercial
�f Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
�j 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 Historic preservation
If this is for a demolition permit, what year was t� building constructed?
of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/Cr must list licensed electrician.
Subcontractors. List the company name or City of Ft Collins license #
Electrician Plumber
Mechanical Roofer&tn.YCQCi1 tS 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
Revision date 216W17
Date