HomeMy WebLinkAbout655 ZUNI CIR - APPLICATIONS - 1/26/2018From: 01/26/2018 11:59 #884 P.002/0022
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City of Planning, Development, & Transportation services
rt Collins Community Development & Neighborhood Services
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281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ qpKolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
eating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ 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 # � � COO D LQT I Date V, (Q�d76
For office use only
lob Site Address (requi ) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
:kntName Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? 03iere ❑ Report
SaAestax number & required byall contractors. Are you paying with your trust account? WYes ❑ No
3S�ns
Is this a residential or cormliercial project? ❑ Residential ❑ Commercial
If residential, is it: SYSingle 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 (expl�yn)
Is this building 50 years of age or more? ❑ Yes CrNo 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
*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 R Collins license 0
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: ► e nn'.9 --- XI(/
PrintName:�Ut��Q_ G\e`�rr,. Signature . r,►� Date
Revision date 21&2017
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