HomeMy WebLinkAbout608 S GRANT AVE - APPLICATIONS - 7/3/2018City of
F„�ort Collins
Planning, Development & Transportation
281 N. College Ave P.O. 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 replacement A 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.
Application #_ _b- 116,0016) R__3 Date 7
For office use only I
Job Site Address (required) Sr U ,S.;., /
t o/l. Value of Construction (labor, materials, profit)
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Property Owner Name Address
C-O U City/State' ro// ZipeuSa / Phone 70
714
Applicant Name o/t/a n c de I Address
City/States 0/0 r Zip goST6 Phone
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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? ❑ Here ❑ Report
Sales tax number is required by all contractors.
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Are you paying with your bust account? ❑ Yes ❑ No
Is this a residential or commercial project? residential ❑ Commercial
If residential, is it: J21tingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex /
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail S
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? *Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work. cr e ¢ �� �_ �t y C1 / z
*If lawn sprifler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Oty of Ft Collins license # � '
Electrician Plumber Mechanical RooferC }?'�1 Othe
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: S k, 01- V SA L h CkCk Signature F �L�� ,� Date —7 — 3—le
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