HomeMy WebLinkAbout417 PEARL ST - APPLICATIONS - 7/23/2018tyo
Fort 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 in orlma(tion on the application.
Application # U( ME
For otrjae use only
Incomplete applications will not be accepted.
Date
Job Site Address (required)
Sr --W . value of Construction (labor, materials, profit)
w 7
� -7, 20
Property Owner Name Address
Gty/ tate_-�E, 'i ZipJ�e�S� Phone
Applicant Name A4/ca ^ c e cd Address
City/States o f �° `� Zip �75 Sb Phone 4D
aP 1 --Cre-k'\ 0 1 ,es 9456s
; Oc�Kd Pf\�LOoa0
Contractor Address
City/State Zip Phone
7'Y- 0.d Vo'lti Q, k 1 I to I
ll
. vv\
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by aif con&acfors.
Are you paying with your trust account? ❑ Yes ❑ No
� J r) S Cr.
Is this a residential or commercial project? 'Residential ❑ Commercial
If residential, is it: ,I� Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
�Cjj 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? des ❑ No If yes, you may need to contact Historic Preservation IJ
If this is fora 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
lawn sprihkler/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 # �n
Electrician Plumber Mechanical Roofer rC'}Y-,.G, 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:
Print Name: L G IA C k Signature
Dated —