HomeMy WebLinkAbout418 STARLING ST - APPLICATIONS - 12/17/2018Planning, 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.
Application # �n l
1
For oft le us only
Incomplete applications will not be accepted.
Job Site Address (required) Value of Construction (labor, materials, profit)
qla Siorltn F G 52 �32=
Property Owner Name Address City/State Zip Phone
T 115 k. 2 M-0112-92(33
Applicant Name Address City/State Zip Phone
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Contractor Address City/State Zip Phone
S 9052y L45H1(0 (o
Contractor City of Ft. Co ins 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? XYes ❑ No
102-tq
Is this a residential or commercial project? Wesidential ❑ Commercial
If residential, is it: Single Family Detached ElCondo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church 0 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?
Description of work 2 ociceA 5 W S
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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 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: �A cc L1 g � jtA 01 Date' )2 •11' 1 8
Print Name: (�l�>�+ ,( �f--1 Signature ,.Pi.
Revision date 21612017