HomeMy WebLinkAbout421 STOVER ST - APPLICATIONS - 6/14/2019P30
City of Planning, Development, & Transportation Services
Flirt CollinslCommunity 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 Inf
ormation on the application. Incomplete applications will not be accepted.
Application A q ' -a Date
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Job Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip , Phone
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Applicant Name 4 Address City/State Zip Phone
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Contractor Address City/State Zip L27 C Phone
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Contractor City of Ft. Collins Sale ax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by allconbactors. Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? Residential ❑ 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 � 410 p I ug Lo S
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*If lawn sprinkler/backAow pr, enter, 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: ,Q�
Print Name: J20A "`"r
SSfe'- Signature Date
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Revision date 2/6/2017