HomeMy WebLinkAbout423 FRANKLIN ST - APPLICATIONS - 7/13/2018r 6r�a �arc�91 � �/O�ra� 4 at, � rr p�a p Ip e
Collins Community Deveiopmr nt & Neighborhood Services,
281 North College Avenue
Fort COHins, CO 80,524 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 (chetclt all that apply). Cl Air Conditioning
0 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
0 Heating Unit d Lawn Sprinkler ❑ Mobile Nome replacement ARoofing Cl Sewer Line Cl Photo -voltaic.
❑ Ventilation Cl Water Heater, ❑ Water Line D Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
complete all opplesAble information on the application.
Application #_�
For offlce use Monly
Incomplete applications will not be accepted.
Date
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Owner Name Address City/State Zip Phone
ceC� i(f'4iS� n> � (iSTiri,r-� Ave �Jt to it,�' �..t
Applicant Name Address City/state Zip Phone
O i �-
Contractor Address City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? CI Here 0 Report
Sales tax number isregWredbyallcontractois, Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? 1KResidential 0 Commercial
If residential, is it: I,Singie Family Detached ❑ Condo/townhome (single family attached) 0 Duplex
0 Multifamily (apartment) 0 Garage
If commercial, is it: 0 Bank ❑ Bar C] Church 0 Hotel/Motel C Medical office 13 Office 11 Retail
El Restaurant ® Other (explain) _ Is this building SO gears of age or more? Cl Yes ❑ No Xf yes, you_ may need___
to contact filStO/!C Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work ti i'LI r--:1-,�•.�.. �tlII �C:r�� ,, F-fir
*If lawn sprinkler/backflow preventer, must list licensed plumber. Ftff fitsu-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license �
Electrician __ _ Plumber ______..____ Mechanical--- Roofer � K- fAL � 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. 3 know that a
permit Is not valid until IP, has Been paid and Issued.
Applicant: _ /�J�/ �/�
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