HomeMy WebLinkAbout617 DUKE LN - APPLICATIONS - 5/8/2018City of
F6r t 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). ❑ 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 # bl e66351 % Date S r!
For office use only
lob Site. Address (required) Value of Construction (labor, materials, profit)
A)k_t ( 4-v- $ o 0
Property Owner Name
Address
City/State' Zip
Phone ?70-
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Applicant Name
Address
City/State Zip
Phone
Contractor Lic # i 1�1 �j
Address
City/State Zip
Phone CY1v
LASES t) - Li
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Contractor City of Ft. Collins Sales Tax #
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Are you paying taxes here or by report? ❑ Here
A Report
sales tax number is required by all contractors.
Are you paying with your trust account? g 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 0 Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes )6-No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work l i¢2 0 F Zoe F ? u '14 Lk-, 4e /1&,a t-'
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed el ctrician. '
Subcontractors: List the company name or City of Ft Collins license # /f-kV &ze7-
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: ,�� A/ C C
Print (dame: � � Signature
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Date