HomeMy WebLinkAbout412 THRASHER ST - APPLICATIONS - 12/27/2019of Planning, Development &Transportation
'City
For N. College Ave P.O. Box 580
�t 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 ❑ Ga�§SS 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# I " Date 1z12-7.190/9
For o ice use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
12 Thras her Sf, FC
05 Z(o
Property Owner Name Address
City/State Zip
Phon
— �
erf %l
Sla
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Applicant Name Address
'J�e/� r-/ /�/Z
City/State Zip Phone
!�S`ier Sf %�' C v P5-2,6 ��� S /6
Contractor Address
City/State Zip
Phone
A
Contractor City of Ft. Collins Sales Tax # fi/A-
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? [), tesidential ❑ Commercial
If residential, is it: O'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 o Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? r<!OZ4
Description of work Rep /a e �l h o t<1 h-ea �P r /f 0 0l
nv,r add drellh ✓o" a -a i4 %/der 9-t°
*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 # IV/.q—
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:rJ/Jp/ L • Fl 2
Print Name: �/h n Signature Date