HomeMy WebLinkAbout6107 MELROSE CT - APPLICATIONS - 3/23/2017City of Planning, Development & Transportation
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281 N. College Ave P.O. Box 58o
Fort `� '` .toms 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 ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 1�( Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application.
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Application # � I � G) I
For office use only
Incomplete applications will not be accepted.
Date 3 1 Z-31 (%
lob Site Address (required)
- Value of Construction (labor, materials, profit)
Property Owner Name Address
PO,
City/State
Zip 8LYDZ 5
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Applicant N me U Address
GL:-T P�W'
Cil.iti�!✓'r 465 ,e,nV
/� City/State
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Zip
Co &53-1
Phone
U,2�5-a1311
Contractor Address
Zip
Phone 696-
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Contractor City of Ft. Collins Sales Tax #
11
Are you paying taxes here or by report? a"Here
rJ Report
Sales tax number& required by all contractors:
7)]
Are you paying with your trust account? - Yes
14 No
Is this a residential or commercial project? _P Residential ❑ Commercial
If residential, is it: 11�lmgle 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 ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of works
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty of 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: ��jj na4 Print Name:& Y r I' LrAJ9,V Signature
Date 3) '? )/ /1
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