HomeMy WebLinkAbout219 E ELIZABETH ST - APPLICATIONS - 10/2/2018City f Planning, Development & Transportation
Fy O281 N. College Ave P.O. Box 580
ort Collins Fort Collins, CO 80524
Phone 00-416-2740 Fax 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 informations on the application
Application # --I ft
For office use only
Incomplete applications 'll of be accepted.
Date40ti
1. ,'
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip Phone
605_23- 3-&
Applicant Name Address
City/State Zip Phone
Contractor Address�! NSr Cif/Pate Zip Phone
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225--22k 2
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? UlHere ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account? [Yes ❑ No
Is this a residential or commercial project? E Residential ❑ 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? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work /NS/it-tc 46*5 723 aA., iT /4,frtp-
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber I 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: t AAtC f Lt 1 L lti Signature
Date �� Z