HomeMy WebLinkAbout617 CORNELL AVE - APPLICATIONS - 9/7/2018From: SCOTT EVANS Fax: (888) 503-7201 To: Fax: (970) 224-6134, Page 2 of 2 09107/2018 12:20 Pia
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Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970AI6.2740 Fax:•970.224.6134
OVER-THE-COUNTER 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 Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pallet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # t 1 aV V(I Date qzt �/8
For oArce use only
lob Site Address (requlred) Value of Constructilon (labor, materials, proflt)
617 !/ Aue. t $a, q3
Property Owner Name Address City/State Zip Phone
CkcinAler 61,7 Cornell /Qve lrort lw O c6A6 6170-6,90-3'�Ly6
Applicant Name Address Clty/State Zip Phone
wi 1 I i a wr rti C r%' 616 3. y/ • 9s 'T
Contractor Address Gty/State Zip Phone
A+ kooFt C "'Co So 16 31 y 01 l5 3
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? ❑ Here a( Report
sales taxnuratber `reps[ �byalimn&acras. Are you paying with your trust account? ❑ Yes IX No
Is this a ressiidential or commercial project? WResidential ❑ 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 yearsof age or more? M Yes O No Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work Re QAt=sfiAo, roof owl, feorgrtn C)WetnS C-OrVktAta P'lii)Q 1'0l1S
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty of At 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: W. Sealy EUctN!s Signature ���'� � Date J.Jyd,0/9
Revision date 216=17