HomeMy WebLinkAbout905 ELM ST - APPLICATIONS - 4/3/2018Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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). O 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
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # a '11i co o a Date 04/03/2018
For ofFce use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
905 ELM ST
$2,670.00
Property Owner Name
Address City/State Zip
Phone
MARGARET SCHNEIDER
41632 COUNTY RD 13, FT COLLINS CO 80524
970-482-8598
Applicant Name
Address City/State Zip
Phone
Contractor
Address I City/State Zip
Phone
NORTHERN COLORADO AIR INC.
812 STOCKTON AVE, FT COLLINS CO 80524
970-223-8873
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?
O Here ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account?
N Yes ❑ No
26862
Is this a residential or commercial project? O Residential ❑ (
If residential, is it: O Single Family Detached ❑ Condo/towr
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes 0 No If ye.
If this is for a demolition permit, what year was the building col
If prior to 1975, you will need an asbestos assessment to submit t
Description of work ADD AC
(single family attached) ❑ Duplex
❑ Medical office ❑ Office ❑ Retail
you may need to contact Historic Preservation
this application.
*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 WIRED ELECTRIC 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: KARENA
Print Name: KARENA HUNTWORK Signature HUNTWORK de101L41W1.X.907W Date 04/03/2018