HomeMy WebLinkAbout3230 BIRMINGHAM DR - APPLICATIONS - 9/25/2018COCaC0 (0
City of Planning, Development, & Transportation Services
Fort 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
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 information on the application. Incomplete applications will not be accepted.
Application # r3j4ZDZZ 41 Date
For ofce use only
Job Site Address (required) Value of Construction (labor, materials, profit)
l r
Property Owner Name Address City/State Zi Phone
1 o L�6 l 1 �-_,--:47- -79o
Applicant Name (� Address, City/State Zip Phone
170 r e a zs f Cif l ,n n 70-0a3 9,so(
Contractor dddress City//SStt/aate _Zi/p� Phone
/'lam �+
1
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
mmercial project? Residential ❑ Commercial
Is this a residential orKslingle
If residential, is it: Family Detac e ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (e p am)
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 wa a building constructed?
Descri tion of work ) h % )o
a ,
0
*If lawn sprinkler/backflow pre In r, must list licensed plumber. If first-time A/Cr m st list c sed electrician.
Subcontracto : List the copa yname or l6Zty 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 comp) to 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
Revision date 21612017 V
,��r>- - _
., ..
;.
_
_
_ . � •
c.
' "F, r.. _,
� - .r
� -
i
,
ii ....
_
...._ _. ._..
_..
i
� ... _ �
_. .. .. _.1.
.. _.
� a .. _ _. ..
r
..
.:
.:. ..
,.: „ ,.. �.. ..,..1
..
_� .- .1
•� �.� r-
- e«,.
�i-:. _ 1.
� '� - �. - .. �4i �.
:. .�
��
�...
�i.y ry
•..
�..4, `A'��'" -1
"�,� :"a 1 �.
R. ,Vk '�ry;bi v� .r .M1'�M ��¢�. l:: :'
4
1e
_
...,
.. ,.