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HomeMy WebLinkAbout626 9TH ST - APPLICATIONS - 7/17/2018 (3)City of Planning, Development, & Transportation Services Flirt 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 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. CJ Application # e" I �yA' For office use only Date r7. VT 1 J 49 60) Job Site Address (required) Value of Construction (labor, materials, profit) Th <1wt' -T- 4 -- - - Property Owner Name Address City/State Zip Phone AmA 19C JQr CtWtvs CC) S2 1-10--oss Applicant Name Address City/State Zip Phone >r[ 3or3 CAmIrg C (At (A 805.24 to-Z73- 3Vo Contractor Address v City/State Zip Phone 0 ey-14f: r 3001 O- CT yr Coll i vS (.0 665'zr • 59 Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report sales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes ❑ No Is this a residential or coo mercial 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? 9 Yes ❑ 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 *-' T •� 5 *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: �j TfJ Print Name: V-oV f Signature ` Date Revision date 2/6/2017