HomeMy WebLinkAbout610 S WHITCOMB ST - APPLICATIONS - 1/7/2013Planning, Development & Transportation
City of 281 N. College Ave P.O. Box 580
Fort Collins 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 sery a change) ❑ Gas Lighter ❑ Gas Log
ent R ❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replaceroofing ❑ 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 # � /"�0� (U
Four office use only
Date I /1 �3
Sob Site Address (required)
/11AC -Glo ccc RAVa AAA140t. (o10.5.
Value of Construction (labor, materials, profit)
Wgd co.W6Sf )9Mw 6 Co 805Z/
Property Owner Name Address
13 IOAUZ MWC►tGL OWA)&L Ztp 4 7 E.
City/State Zip
M014� 6 1G cO&V-y
Phone
970-zvc-_7z0
V
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Sales tax number Is required by a#contractorss.
Are you paying taxes here or by report? ❑ Here ❑ Report
Are you paying with your trust account? ❑ 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) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building SO years of age or more? ❑ Yes XNo Ifyes, you may need to cont ctHistoric Preservation
If this is for a demolition permit, what year was the building constructed? '4
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
t
/backflow preventer, must IVAicensed plumber. If first-time A/C, must list licensed electrician. /44.4-v i eif
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 the above information is complete a correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building co ruction. I know that a
permit is not valid until it
has been paid and issued.
Applicant: Print Name:_ %Uzu - Signature Date �.3