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HomeMy WebLinkAbout222 JACKSON AVE - APPLICATIONS - 3/22/2018City of Planning, Development, & Transportation Services Flirt Collins Community Development & Neighborhood Services 281 North College Avenue Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134 aIU16 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 AGas Log ❑ Heating 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 beaccepted. Application # RACO Q Date 3 I2-1A L(�) For office use only Job Site Address (required) Value of Construction (labor, materials, profit) �C9� q01, Property Owner Name Address City/State Zip Phone Applicant Name Address City/State Zip Phone b u b0Q4 q3t 921 11 Contractor Address City/State Zip Phone Contractor City of Ft. Collins Sales Tax # 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 4� _:f N .4'3r( 5 Is this a residential or con pmercial project? ❑ Residential ❑ Commercial If residential, is it: ingle 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? Description of work PeCi 124lec *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 # Electrician PlumberL P - 1,9 O, 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: Print Name: © Signature 3121 Date Revision date 216/2017