HomeMy WebLinkAbout412 NOKOMIS CT - APPLICATIONS - 4/16/2019City 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 #NbE4_149 Date L41 I tpZot c?
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
71 4 rYi1 S 4- +ak CoI I I n's BOT2
Property Owner Name Address City/State Zip Phone
Wilf-011"IdO 1 Ur k 0-Z `s G( I ins o eCK2 Ll U-
Applicant Name Address City/State Zip Phone
T) Iria \(QS Q wz -zA r. COI I y C Wiz'<. 6_
Contractor Address City/Stat Zip Phone
t z3 a(id Ot. Sn W1 co 8eQ-< 9`9-C-910 (�2�
if e1 i ny.
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 com�mercial project? ❑ Residential ❑ Commercial
If residential, is it: Mingle 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 Qemae r-vl&fe- I IUytr nF IGrnindtJ
Schl�l�r.t . apicro,
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*If lawn sprinkler/backflow preventer, must list I en a plu fiber. If first-time A/1C,, 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:
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Print NameD Signature Date
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Revision date 216/2017