HomeMy WebLinkAbout425 THRASHER ST - APPLICATIONS - 6/13/2018� F�ity Of Planning, Development & Transportation
ort Collins 281 N. College Ave P.O. Bo:; S80
Fort Collins, CO 80524
Phone 970-416-2740 Fax 22-1-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). Air�_oryditi ring
Demolition (interior non-structural) Electrical Alteration (not service change) Gas Lighter f Gas Log
Heating Unit Lawn Sprinkler Mobile Home replacement Roofing Sewer Line PhoEo=Crattaic—`
Ventilation Water Heater bVater Line Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer}.
Complete all applicable information on the application. Incomplete a I'
Application 4t CQ)4( )j 9
For oftrce use only
Job Site Address (required)
-)r
Property Owner Name
<J U D 12 DievJ qz-
Applicant Name
Contractor
lrVt S Y2t l t Ixrtl�Ace SiL'PPL
Contractor City of Ft. Collins Sales Tax ,7
Sales fax number is required by al/ contracto
Is this a residential or
if residential, is it:
oo Icatrons will not be accepted.
Date
C• t� u
Value of Construction (labor, materials, profit)
3 Ir2-
Address
I` {/
C
rity/State t ( /1{lf�, 7 �%r
li
1 VV V LEI 4
Phone �}J
/ .�+-!
Address
City/State ZIP
Phone
Address
City/State -'�—
ZIP
Phone
i4ee'! gwLf�'DC PIZ F-e-.ILD
Are you paying taxes here or by report? Here
Are you paying with your trust account? Yes e ort
No
Commercial
hlultifamil-.•nhome (single family attached) Duple;K
IF commercial, is it: Bank y (apartment) Garage
Bar Church Hotel/Motel Medical office Office Retail
Restaurant Other (e:<plain�
is [his building a years page or more? Yes No If yes, you may need to contact flisfonc Preservation
;f this is for a demolition permit, what year was (he building constructed?
If prior to 1975, you roil/ need an I sbestos assessment to submit bviGh this application.
Description of work
rr.
t �� `)Lq t,( 55
''If lawn ssrinkler/backflow preventer, must list IicenSeii plumber. If first,drne A/C, must list licensed electrician.
Subcontractors: List Ure cernoan), name orQCynfFt �Oilins license .-�
0:•sncian Plumber
��lechanical Kcorer
---"'—'-- — Other
1 hereby adcner+ledge that I have read this s application and state ,hat the above information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating hulloing cte and
correct.
I know that a
permit is not valid until it has been paid and issued.
Applicant:
Print Name:
Signature
Dater----