HomeMy WebLinkAbout1809 N COLLEGE AVE - APPLICATIONS - 6/5/2019City of Planning, Development, & Transportation Services
Frt 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 ,KRoofing ❑ 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 # !'1 1 0-�"l S 9 Date
For office use only
lob Site Address (required) Value of Construction (labor, materials, profit)
(oact �3 - Coo ?$ 14'9 '>- -' - .
Property Owner Name Address City/State Zip Phon
HOl un Choi Vbc"I WAvel IMs. Go ��5 .70)
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Applicant Name Address City/State Zip Phone
Contractor /�� L Address City/State Zip Phone
ct7eAwrsti,-m) ( 3 �Z+►1 +. (Vtc_. '1*5 S 05 0 rok . (,IArom Ci0 0001 �'.
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required byall contractors. Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential 8 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 mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work p l6� 1, 6n, e�-Crczykd �lAobT A
*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 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: ,,gg
Print Name: <<2� Wl� �F �"" Signature- Date �(Q
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Revision date 216/2017