HomeMy WebLinkAbout1418 ASH DR - APPLICATIONS - 6/25/2018 (5)e �a
/ FCity of Planning, Development, & Transportation Services
ort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins CO 80524 Main 970 416 2740 Fax 970 224 6134
1, 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) 0 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 �a � �civ
Application # bin (i4 g t! b Q m 0- Date ��� Qsw 0
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
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Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? "ere ❑ Report
Sales tax number rs required by all contractors Are you paying with your trust account? VP(es ❑ No
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Is this a residential or commercial prolect7 esidential ❑ Commercial
If residential, is it Imgle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
C 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 ❑ No If yes, you may need to contact Histonc Preservabon
If this is for a demolition permit, what year was the building constructed7i
Description of wor
*If lawn sprinkler/bac(flow preventer, must list licensed plumber If first-time A/C, must list licensed electrician
Subcontractors List the company name or City of f7 Collins license #
ElectricianrL�_ Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and stage 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 _C��tras`. a;,e)i;\yr Signature Date l0 �• nyi��\1
Revision date 2/6/2017