HomeMy WebLinkAbout810 E MYRTLE ST - APPLICATIONS - 9/24/2019City f Planning, Development & Transportation
Flir y o281 N. College Ave P.O. Box 580
rt 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 ❑ Electrical Alteration ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler
❑ Mobile Home replacement ❑ Sewer Line ❑ 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 # G ` l I � `^ I Date
For office use only
lob Site Address (required)
Value of Construction (labor, materials, profit)
8i®- I_
5
Prope Owner Name Address
City/State Zip Phone
LAvRrJ SVLLIVA^/ J
970-63(-
( P U E Mq RTLE S
Col LINS Co o52-
Applicant Name Address
City/State Zip Phone
E I Eel 6 E N
(LLVOF co RoS Z 7U' 7-3 5
Contractor Address
City/State Zip Phone
JZJJ,J/JPT1C EI,iz I -I C 1700 W to
(,F ST R)P--V CoL4(NS co PJaS21 170 - 8 (7 - 7i 199
Contractor City of Ft. Collins 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? ❑ Yes ❑ No
Is this a residential or commercial project? Wesidential ❑ Commercial
If residential, is it: IkSingle 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 �rNo 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 NowER FOR NEw li6T- -rv3 uNgF,,2ce-bu�jf) �f12t°�lCtl
I.dSeF-G-`T(6:J WA'S bnr� art A-ooe%ie.J iI
*If lawn sprinkler/bacidlow 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: \
Print Name: ()44*Q ttF/L (-%ArQQrL.- SignatureDate 9 2 ci