HomeMy WebLinkAbout612 ALPERT CT W - APPLICATIONS - 11/21/2018Planning, Development Sr. 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
❑ Heating Unit tJ 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 # _ Date
For office use only
Job Site Address (required)(PQ_W. & PB(� °'Value of Construction (labor, materials, profit)'%�6t%l.a
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Property Owner Name Address City/State Zip Phone
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Applicant Name
Contractor
Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by all contractor.
Address City/State Zip Phone
Address City/State Zip Phone
(,�ri Pcciiif;
Are you paying taxes here or by report? ❑ Here DIReport
Are you paying with your trust account? ,p Yes ❑ No
Is this a residential or commercial project? `�Oesidential 0 Commercial
If residential, is it: ❑ Single Family Detached J Condo/townhorne (single family attached) _)R} Duplex
Multifamily (apartment) ID Garage
If commercial, is it: ❑ Bank 0 Bar ❑ Church 1Ll 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 "'ill need an asbestos assessment to submit with this application.
Description of work
If lawn sprinkler/backflow preventer, must list licensed plumber. it first-time A/C, must list licensed electrician.
Subcontractors; Llst the company name or City of Ff 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 ii: has been paid and issued.
Applicant:
Print Name: Signature _ L�'1 "^ r�U Z
F— Date