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HomeMy WebLinkAbout412 RIDDLE DR - APPLICATIONS - 10/17/2018City of Fit Collins Planning, Development & Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-416-2740 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 VHeating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ' ❑ Roofing ❑ Sewer Line El 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 # PJvfrJQU��44 Date /�/ B For ofce use only Job Site Address (required) Value of Construction (labor, materials, profit) yl a glxt-E S! FbAl—emt t^jS S 0!�7L I Property Owner Name Address City/State Zip Phone o—tSo,J 06 tt t r r t rfzv)?99-l5P5s Applicant Name Address City/State Zip Phone I goS,S YY✓��ti!a�J� 7l ce;L 1 S • C+M's hy [' _ r-oa-T Co Ermp 1 ('3 Contractor Address City/State Zip Phone )kL- '-N F00F RiUK-6-L.(. Lr t r , r z t Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here VReport Sales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes O No Is this a residential or commercial project? ©Residential ❑ Commercial If residential, is it: tf� 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 pnor to 1975, you will need an asbestos assessment to submit with this application. Description of work ALA try t V *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 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: I ^� 2 /R Print Name:�S N'A'S-o^t Signature AM ' '� Date b i I ;k -�'K'>