Loading...
HomeMy WebLinkAbout440 N ROOSEVELT AVE - APPLICATIONS - 7/25/2018City of Planning, Development, & Transportation Services Fort 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. Application # eiJjbt,2 11 Date • z5) 1� For of re use only Job Site Address (required) Value of Construction (labor, materials, profit) U r-lo KDOSEU�Lz f4vE 10I 1, 60 Property Owner Name Address City/State Zip Phone PPWI, WILL.14M S 440 rl eoosEveLTAr FC/L.o 8o101 Applicant Name Address City/State Zip Phone Sion 2%ck- tool E ©AYAU6 Ave: 6CNuEKIc0 80201 of70-21'(-�19 Contractor Address City/State Zip Phone �1 tk 21��c. CO,vsTRvcrtoM LLC 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 commercial project? C! Residential Cl 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? ❑ 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 7CAR p CF A IntsTN L L Z 7- S 4 o4�_ Ca rn P SH i tJo- LCIS S 12 Pt TCH 9 STOQy OC Oyt1Artof4 S-r6RM. *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 (ZooFo L 0 C. 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: I 7 �25 I Print Name: / Signature Date Revision date 2/6/2017 tX.-_W_