HomeMy WebLinkAbout6126 CARMICHAEL ST - APPLICATIONS - 6/27/2019il}"Gl Pfannf)7g, D'r?IAei`aPM6=, & Tr8UFP0rtat10n* SerVICeS•
Fort Collins Cam=,- nityr Ds-vefWfrieat & Nefgftborhood Services
22t NhrrY.CoI1 Afefarre
orCGotlics Co0.52E 15f&iir 92U4 f>?]� Fax: 97Q.224',61�.
44-1-1
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
r on the application. Incomplete applications will not be accepted.
Application # ✓ 1 �� ` 5' l� Date
Far office use on/v
lob Site Address (required) Value of Construction (labor, materials, profit)
19iU Car Wii&0 0 e6 S� - �DA CO1iK 100 M2� g Sa S
Property Owner Name Address City/State Zip Phone
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Applicant Name Address City/State Zip Phone
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Contractor Address City/State Zip r Phone
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Contractor City of Ft. Ilins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
sales tax numaerisraquiredayaiiconbocmrs. Are you paying with your trust account? )iYes ❑ No
is this a residential or commercial project? XResidential ❑ 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? ❑ YesgNo If yes, you may need to contact Historic Preservation
If this is fur a demolition permit, what year was the building constructed?
Descriptio of wo l V� (tik Vt - VLSIVl -6S /�
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*If lawn sprinkler/bacldiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the cvmpanyname Or Gty of Ft Collins license # ther i1
Plumber Mechanical Roofer V1�
f]ectrician JJ
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 Ja
permit is not valid until it has been paid and issued. p %�
Applicant: /, t V1 Y V tC�V�l�1` Si nature l/l/1�i�itiYc � f/ V t c�^`��C Date S
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Print Name f t �V f I U g
Revision date 2A=17
11