HomeMy WebLinkAbout826 W MAGNOLIA ST - APPLICATIONS - 8/10/2018UVLK- I fit-GUUNTER 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
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Una ❑ Photo -voltaic
0 Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application. tncomplele appy dons will not be accepted.
Application # �.��� �0�3 Date �i
For olflce use only
]ob Site Address (requirad) Value of Construction (labor, materials, profit)
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Property Owner Name A dress City/State ZI Phone
Applicant Name Address ty/State Zip Phone
Contractor Address city/state Zip y Phone
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Contractor City'of Ft. Collins Sales Tax # Are you paying taxes here or by report? kilere ❑ Report
Salesbxnumberisrequtredbyall cnafracbrs Are you paying with your trust account? 6-Yies ❑ No
Is this a residential or commercial project? dential ❑ Commercial
If residential, Is it d?Single f--amlly Detached ❑ Condoltownhome (single family attached) ❑ Duplex
(❑ Multifamily (apartment) ❑ Garage
If commercial, Is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Mobel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you may need to contact Hista dcpfeseruabr6n
If this is for a demolition permit, what year was the building constructed?
Description of work v
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*If lawn sprinlder/baddiow prevenber, must list licensed plumber. If first-time A/C.. must list licensed electrician.
Subcontractors: Llstdre companyname or Gty offtCohlinsllcnnse #
Flectridan 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: K1;3- l i Data
2m4sLw date 2/G=7 /