HomeMy WebLinkAbout910 E STUART ST - APPLICATIONS - 6/21/2019Ci Ly 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 #�9��'���
For oSrce use only
Date
Value of•Construction (labor, materials, profit)
Job Site Address (required)
I it) E
property Owner Name Address
City/State Zip
Phone
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Applicant Name Address
_
City/State Tip
Phone
Contractor Address
City/State Tip
Phone
Contractor City of Ft. Ilins Tax #
Are you paying taxes'here or by report?
Are you paying with your mist account?
❑ Here-- ❑ Report
❑ Yes ❑ No
saiestax number isrequired byall om actors.
Is this a residential or commercial project? 0"kesidentiai ❑ Commerc
ial
nhome stngle fami ry attached) •
❑ Duplex
If residential, is it: FfSingle Family Detached ❑ Condo/tow
❑ Multifamily (apartment) ❑_Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ .Hofel/Motel ❑Medical office ❑Office ❑Retail
❑ Restaurant ❑ Other (explain).-
7s this building 50 years of age or more? ❑ Yes dNo. :lfyes, you mayneed to contacthl;toric Preservation
If this is for a demolition permit, what year was the building —constructed?
of work
L.t-4
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the company name or City of Ft Collins license # l/
g � Plumber.Med,aniol Roofer • HZt 1t 4Z 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 Nam
Signature Ir
Date 0 " I 1
Rev'sbn date 2ro=17 ��