HomeMy WebLinkAbout143 N MCKINLEY AVE - APPLICATIONS - 4/10/2018Cityof Planning, Development, & Transportation Services
Fort Collins Community Development & Neighborhood Services
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
❑ 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 Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
. manufacture
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # Date
For offce use only
Job Site Address (required") Value of C str ction (lalyiaterials, profit)
AI
Property Owner Name Ad ess City/State Zip Phone
Applica Name Address City/State Zip Phone
02 4/ %. 360041,400A 67, G Cfl52_Zy5 �Z 8
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?y4iere ❑ 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? sidential ❑ Commercial
If residential, is it: Ingle Family Deta Zed ❑ Condo/townhome (single family attached) ❑ Duplex
tMultifamily (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
*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 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: ��j� I p\
Print Name: "' t 4`� (�/ Signature Date /O
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Revision date 28/2017