HomeMy WebLinkAbout625 ROCKY MOUNTAIN WAY - APPLICATIONS - 4/13/2018City of 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
manufacturer)
Complete all applicable information on the application Incomplete applications will not be accepted
Application # &%g,6ss Date 1,-20/1
For office use only
lob Site Address (required) Value of Construction (labor materials profit)
LI,2� Z C, J � L, (� ",In GJ * ' //!�o;6-qqc."2al
Property Owner Name Addres/s� City/State Zip Phone
Applicant Name Ad ress City State Zip Phone
' e eo 3
Con ractor 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 allcontradors Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? VResidential ❑ Commercial
If residential is it ❑ Single 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 0 No If yes you may need to contact Histonc Preservation
If this is for a demolition permit what year was the building constructed?
Descript n of work a..
- as a s
*If lawn sprinkler/backflow preventer must list licensed bit imher 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 ff
Print Name e /CU Signature Date /
d t 2/6/20V