HomeMy WebLinkAbout41 S TAFT HILL RD - APPLICATIONS - 12/14/20164-%
T/ra
// Planning, Development & Transportation
City of /1/�d� 1 281 N. College Ave P.O. Box 580
F®rt Collins n07 . Fort Collins, CO 80524
f y ( 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 ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
O Ventilation M'Water Heater ❑ Water Line O 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 # Date /z )/Z'4 //Cp
For office use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
`f/ S. 74-F �'/I ? J. $ *:J(�)d2
Property Owner Name
N ;chore I Mar >~ ; r.i
Address City/State
'/ .S . wa i f u;) Ia ';:� C .
Zip
S o 5- 'i
Phone
303 - 70 - y Sao
Applicant Name
Address City/State
Zip
Phone
Contractor Lic # Address S4 City/State p Zip
�YYrY t-i!'4H i�lY>` JJ//,, . #-/7A9 ,3�i r eat-d,,7 O�.#F � e,-,dSOr. eo. OU:j.�G
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?
Sales taxnumber isrequired byall con&adors 1393411 Are you paying with your trust account?
Phone
970
ere ❑ Report
Yes H'No
6--tw•'f Oe et
Is this a residential or c9mmercial project? b Residential ❑ Commercial
If residential, is it: 0 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 [TNo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pnor to 1975, you w/ll need an asbestos assessment to submit wif this appl/catlon.
Description of work
W
*If lawn sprinkler/back low preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors;
C List the company name or ty of Ft Collins license #
ElectricianWil ee, 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: (�c( �o / /
Print Name: " "�Y l/ Signature[rt� Date lZ -J �'177 - /