HomeMy WebLinkAbout925 COLUMBIA RD - APPLICATIONS - 12/20/2018Cityof 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 #27\M\ 61A Date 'Decetiz7ber-20, 2018
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
925 C&UWi ,:ivRc1,#725, FortCoib( w, CO 80525 $1518.00
Property Owner Name Address City/State Zip Phone
E)ow 'Staccery Lw04 576 W 148tYvAve#101 We�tm.Lnaier, CO 80023 303-725-9348
Applicant Name Address City/State Zip Phone
CTwiwwta/i va4rZ 101 S LLnkLmn& Ft Co; CO 80524 494-7632
Contractor Address City/State ZiPP Phone
AU,ewkSe N6c,e 101 S L(/ La -Le Ft-C&,, CO 805Z4 484-4841
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑�iere ❑ Report
Sales taxnumberIsrequkedbyal/contractors. Are you paying with your trust account? Yes ❑ No
10010
Is this a residential or c mmercial project? `'1 Residential ❑ Commercial
If resldential, is it: V 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 Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work Remove ex✓°tw�w/Ivccncire�laca w th nets iCketv/iv
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or G'ty 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:
Print Name: Cj1�'t YIQi �v 1� Signature .i V l l l ll_ 1,L�'��J Date
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