HomeMy WebLinkAbout6713 HOLYOKE CT - APPLICATIONS - 5/7/2018City 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 cj.# a093
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 XGas 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 #
For office use only
Date �7Zz
Job Site Address (requred) Value of Construction (labor materials profit)
CQ 7/ o-L" SOU o-Z)
Pro erty Owner Name Address City/State Zip Phone
cK 73cII 67/3 A--tol c oi�c- CT ert Co 1 ns CD &s-,z45- 3;--7-
Applicant Na Address City/State Zip Phone q-70
V-e Pro j�L_ [ 1533,7- S T,n�/��'/� I)e %a) 1=TG ZQS2-? at3-11
Contractor Address City/State Zip Phone 1-7 6
r—Vr,e Po _E�NlC 533 ? S TTi rim Seri /) e /2c F-1-G ?&s Z2 3 � l 3 r 7iCP
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? kHere Report
Sales tax nu be is requved by all contractors Are you paying with your trust account? ❑ Yes No
Is this a residential or commercial project? (,(Residential ❑ 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? ❑ YesX 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 en->vv'eloxi �tS r act--
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*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 ,— / /
Print Name L Jul M/CAZ4'�-_ Signature Date �! 7` l
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Revision date 2/6/2017