HomeMy WebLinkAbout625 S WHITCOMB ST - APPLICATIONS - 10/17/2012Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 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 Afteration (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 #
For ofi e tze only
Date III I -1 I I r'
lob Site Address (required)
Valuefff Construction (labor, materials, profit)
bl21 S, L-) 4 1%/6 oA � S7-2 b, D D
Property Owner Name
Address City/State Zip
Phone
Y o f t' w t> If
C`°� lam, 41; 2
V1-
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Applicant Name
Address City/State Zip
Phone
�aJoti oer 76
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Contractor
Address City/State Zip
Phone
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J�ireaf e%l/tis Ca, as'
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Contractor bty of Ft. Collins Sales Tdx # Are you paying taxes here or by report?
❑ Here ❑ Report
Saks tax nnmfxresmqu# dbyanconbadws
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? g Residential ❑ Commercial �/
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) yp Duplex
❑ Multifamily (apartment) ❑ Garage P
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? O Yes O No If yes_ you may need to contactHistor/c Pneservadon
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you wi// need an asbestos aunt to submit witlr this appliwhon.
Description of work
*If lawn sprinkler/backflow preventer, must fist licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Lot the cwnpany name or Oty of ft Collins Axyzw #
Eiectridan Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above infomwtion 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.
P Print Name: � s �' a Y'1 � a r C Signature Date. Z