HomeMy WebLinkAbout616 W OAK ST - APPLICATIONS - 12/4/2012Fort 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 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).
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Complete all applicable information on thlication.
Application # 1
For office use only
Incomplete applications will not be accepted.
Date
Job Site Address (required) Val9p of Construction (labor, materials, profit)
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Propej Owner Name Address
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City/State Zip
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Phone
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Appli nt Name 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 ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) 13 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 ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
of work
4�a
*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 14 . 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 egulating building construction. I know that a
permit is not valid until it has been paid and issued.
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Applicant:
Print Name: 4 e6LV Signature Date �� ��