HomeMy WebLinkAbout219 E ELIZABETH ST - APPLICATIONS - 10/23/2019FCity of I Planning, Development & Transportation
OIL Collins 281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER -:PEMMITS ONLY
This application Is to be used to apply for the following permits only (check all that apply). Air~ ning
Demolition (interior non-structural) Electrical Afteratipn (not service change) Gas Lighter Gas Log
Heating Unit Lawn Sprinkler Mobile Home replacement Roofing Sewer Line Photo -
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 ap Ii t'
Application #
. For office use only
Job Site Address (required)
Owner Name
Applicant Name
Contractor
wt-zr PA-j n s4)reL' .
Contractor City of Ft. Collins Sales Tax #
Sales far number is required by all mntrac7o
Address
I r.! I67�. �l I
Address
p ca Ions will not be accepted.
Date
Value of Construction (labor, materials, profit)
City/State Zip
City/State Zip
Address
l4 06 I21J t phi -G
Zip
2i524
Phone
Phone
Phone
Are ygu paging, taxes here or by report? Here e rt
Are jrRu paying with your trust account? Yes
o
Is this a residential or com erefal-prc jF esidential Coglmerdal
If residential, is it: Single Family acono wnhome(single family attached) Duplex
tifaml y (apment) Garage
If commercial, is it: Bank Bar Church Hotel/Motel " Medical office Office Retail
Restaurant Other (explai
Is this building 50 years of age or more? Yes o If yes, you may need to contact HIstonc Preservation
If this is for a demolition permit, what year was the ding constructed?
If prior to 1975, you will need an asbestos assessment to submit with this apphcab'on,
of work
I vl
*If lawn sprinkler/backRow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
subcontractors: L/st the company name or City of Ft Collins license 0
Electrician Plumber
Mechanical___ Roofer
—__ Other
comply with all requirements contained herein and city ordinances and state laws reguI hereby acknowledge that I haveyead this application and state that the above information Is complete and correct. I agree to
lating building construction. I know that a
permit Is not valid until It has been paid and issued.
Applicant:
Print Name: t� Signatures
Date