HomeMy WebLinkAbout616 W OAK ST - APPLICATIONS - 12/7/2012City of
F\rt 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 ❑ 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 informations on the application. Incomplete applications will not be accepted.
Application # 8rL4 7�� Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
S o Zip $ / 3 0`0
Property -,Owner Name Address
City/State Zip
Phone
Applicant hame Address
City/State Zip
Phone
Contractor Lic # Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by all contractors.
Are you paying taxes here or by report?
Are you paying with your trust account?
❑ Here ❑ Report
❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Cyynndo/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? ❑ Yes o If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? /c%
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license # /
Electrician Plumber Mechanical ✓ Roofer Other
I hereby acknowledge that I have read this application and state that
comply with all requirements contained herein and city ordinancesi
permit is not valid until it has been paid and issued. ,
information is complete and correct. I agree to
s regulating building construction. I know that a
Applicant: �j L
Print Name: V_ 0r • t Signature Date AZ