HomeMy WebLinkAbout508 Remington St - Applications/Other - 12/09/2014Dec 08 14 07:20p FyrePro
9702253870 p.4
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 97D-416-2740 Fax 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 LinP� ❑ Photo -voltaic
❑ Ventilation Q Water Heater ❑ Water Line iVcWood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all appliiAable information 1 Qn the application. Incomplete appiicatio s will not be accepted. X?
Application #. 9�J I �� a �4 Date
For offlce use oniy
]ob S' Address (required) Value of Construction (labor, materials, profit)
Pro erty Owner Name Address City/State Zip
l� i i Crf -
Phone �o)L
t G �a
7."-93X
Applicant Name
Address �— City/state _ ZIp
Phone
tractor Uc: #
Address City/State Zlp,
V�
Phone -7 ,
1?_ -
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? 01�lere
❑ Report
'Wertaxnumbe-isiegwredbya#mn&aaors Are you paying with your trust account? ❑ Yes
. `1�CNo
Is this a residential or commercial project?
If residential, is it: 13 Single Family Detach d
Multifamily (apartment)
If commercial, is It: ❑ Bank ❑ Bar ❑ Church
1 ❑ Commercial
❑ Condo/townhome (single family attached) ❑ Duplex
❑ Garage
❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explai )
Is this building 50 years of age or more? ❑ Yes 4No Ifyes, you may need to contact Historic PraseWbOn
If this Is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you WIl need an asbestos assessment to submit with &is application.
Of
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must Fist licensed electrician.
Subcontractors: List the company name or Cty of Ft Coffins license #
Electrician Piumber 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:
Print Name: ' ' Signature Date /�