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HomeMy WebLinkAbout932 E PITKIN ST - APPLICATIONS - 11/19/201211/19/2012 12:11 FAX raoo1 Fort 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 Alteration (not service change) ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler D Mobile Home replacement ❑ Roofing ❑ Sewer Line 0 Photo -voltaic ❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable jinformation �on the application. Incomplete applications will not be accepted. Application # Date For at>/ce use only Sob Site Address��(required) • _ Value of Construction (labor, materials, profit) � �6 G `� t% Property Owner Name Address City/State zp Phone- f� 93,-A�- ; F.Cal C , .s- Applicant Name Address City/State Zip Roo i -Lefmv a'A-3-fN2. Ft'- C'bllrYly,(D. 8CSrq Phone TV-qq3-35SG Contractor �+� fY] P 7`i Colc Address City/State Zip Phone NarthErn c�el1 7Nq• a.tt'ifiQt �A 1W2 FI, L�oil+ns C6. 7X Contractor City of Ft Collins Sates Tax # Are you paying taxes here or by report? X Here ❑ Report "es tax number istwulreabyarmnbwdom Are you paying with your trust account? ❑ Yes )(No Is this a residential or co erdai project? 5-Residential ❑ 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 C] Medical office ❑ Office ❑ Retail ❑ Restaurant ❑Other (explalr Is this building 50 years of age or more? El Yes No If yes, you may need Lv crontact H/s1oNc Presenadon If this Is for a demolition permit, what year was the building constructed? Ifpdor to 1975, you will need an asbestos assessment to submit with this applicadon. re *If lawn Wnnkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: List the company name or Qy of At Collins license 0 Oedridan Plumber Mechankal Roofer 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 penult is not valid until it has been paid and hrsued. Apppcant: � Print Name: f` V( ' 10 . f IC 1 L SCI 1 Signature �� Date