HomeMy WebLinkAbout636 W COY DR - APPLICATIONS - 3/20/2019City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
' Fort Collins 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 ❑ Lawn Sprinkler ❑ Mobile Home replacement 01Roofing ❑ 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 accented
Application # 131 qb l IQs-Z
For office use only
Job Site Address (required)
Property Owner Name Address
Aee0.vsdo (031 W. 1
r/(pplicant Name \ Address
Contractor
Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by at/ contractors
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Date
Value of Construction (labor, materials, profit)
City/State Zip Phone
City/State
Address City/State
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Zip Phone
Zip Phone
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Are you paying taxes here or by report? E4-lere ❑ Report
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? eResidential ❑ Commercial
If residential, is it: ❑ 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 G]'No if yes, you may need to contact H%stoncPreservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work I2< Q (-- ct orrVAc
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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 3 /
,2_ 8 `/ 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 a state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant:
Print Name: obalkf Signature
Date &-zo-/y