HomeMy WebLinkAbout925 ROCKY MOUNTAIN WAY - APPLICATIONS - 2/4/2019i.
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Ui y"' g Planning, Development, & Transportation Services
®rt®�`1ns Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80624 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 ❑ I -awn 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 # I a Date
1-ur office use only
]ob Site Address (required)
Propertv Owner Name
Applicant Name
Contractor
SPi'a A et
City of Ft. Collins
Value Of Construction (labor, materi
als, profit)
=TG
Sri f-s
Addres City/State
Zip Phone
Address
Address
ar7
es Tax #
Sales tax number Is required by all contractors.
City/State Zip Phone
City/State Zip Phone
R7
Are you paying taxes here or by report? ❑ Here ❑ Report
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? IR Residential 11 Commercial
If residential, is it; lZI 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.X No If yes; you may need .to Contact HistorlcPreservation
If this is for a demolition permit, what year was the building constructed?
of work
tJ rS
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list
Subcontractors: List the company name or City of Ft Collins license e
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 Nam
Revision date U12017
6- Signature
Date a - y- 13