HomeMy WebLinkAbout830 AZTEC DR - APPLICATIONS - 6/14/2018City of
Fort Collins
Planning, Development & Transportation
281 N College Ave P 0 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 replaceme;,ove((must
Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet be EPA certified provide make, model and
manufacturer)
Complete all applicable information on the application Incomplete applications will not be accepted
/' I
Application # I s64y 3� Date /%�
For office use only
Job ite Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
# City/State Zip
Phone
: g
905_21Z3z
Applicant Name Address
City/State Zip
Phone i
Z2�e_ e_0 9L2s—';�
9w- ew-z.3
Contractor Address
City/State Zip
Phone
11-17
455�iI/
Contractor City of Ft Collins les Tax #
Are you paying taxes here or by report?
❑ Here rReport:
Sales tax number is required by a// contractors
Are you paying with your trust account?
❑ Yes _Iq-No
Is this a residential or commercial project? esidential ❑ 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? ❑ Yeso If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pnor to 1975, you will need an asbestos assessment to submit with this application I
Description of workL' I
*If lawn sprinkler/ ckflow preventer, must list license umber If first-time A/C, must list licensed electrician
Subcontractors List the company name or City of Ft Collins 11cense #
Electrician Plumber Mechanical Roofer .G_7E Other
i
I
i
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 �i��?�1i��5 Signatur Date