HomeMy WebLinkAbout2202 HARVEST ST - APPLICATIONS - 7/9/2019Uly, 07` Planning, ®eveiopment,, A d ranspodation Services
� 6rt C®��9Bil s Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
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 A Gas .6eg F'retolace
❑ 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 # t� f 90 `4 35':'-5
For oSrce use only
Date 7 'qzl%
Sob Site Address (required) Vague of Construct (labor, materials, profit)
1-40 Do
Property Owner Name Address City/State Zip Phone Y02—
a%i flt n f5u aaoa �%Lr✓ /o r e Cal It k'z-5 5l)SZ9 497- eno
Applicant Name Address City/State - Phone
�L0� !L� L' c>L) i�S �� S� Li��7�2Cv�2
Co tractor Address Ci /State Zip Phone
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Jere ❑ Report
Salestaxnu er sr�gi/imd�llral/rontractors Are you paying with your trust accounts ❑ Yes �No
Is this a residential or commercial project? KResidential ❑ Commercial
If residential, is it: Xsingle 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 SO years of age or more? ❑ YesX'No Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work r 5� 7�
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*If lawn sprinkler/backflow preventer, must list licensed plumber. %f first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Co/tins license #
Electrioan 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: Date
I 6-
Print Name-, UVL r Signature
Revision date 2 2017