HomeMy WebLinkAbout600 S WASHINGTON AVE - APPLICATIONS - 9/6/2011Sep 06 2011 1:37PM HP LRSERJET FAX
970-663-4097 page 2
�tafC Hins
planning, Development & Tro"POrtalion
281 N. College Ave P.O. Box SW
Fort Collins, CO 90524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be wed to apply for the following permits only (check all that a~. 4Vit Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Lop
)Vl4eafing Una O Lawn Sprinkler O Mobile Home replacement ❑ Roofing ❑ Sewer Line O Photo -voltaic
O Ventilation ❑ Water Hester ❑ 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 # I I D-1 143 Date S- C- /i Pcuct
for oRAre rase only
lob Bite Add ass (required)
Value of Construction (labor mateAal% Prda)
600 S • ,'
4L_
F4 , eu/
- cl o
Property Owner Name
Address
City/state Zip Phone
Too �► e
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9 ss�'?
Applicant Name 4-At(
Address
City/state Zip Phone
.
A%6ar.Ms Or ie o,,.r`
42-1 bFNvFx
A -we 66 1053-7 99b.61C3
VvOt
Contractor N _ 92,{
Address
City/State Zip Phone
A16L^-J.+s ONE Wo.4,—
L(-j bEwwrA,
Awle� Lotict•wr, ice,. os3-7 970
663 C/001-
Contractor City of Ft. Collins Sales Tax p
Are you paying taxes here or by report? O Here
,'Report
seiesrarrxnran[smquree0yaffwn&saws.
Are you laying with your trust account?Yes
O No
Is this a residential or eornmeraal proud? .Residential O Commercial
If residential, is it: V-Single Family Detached O Condo/townhome (single family attached) O Duplex
O Multifamily (apartment) O Garage
If commercial, is it: O Bank ❑ Bar O Church ❑ Hotel/Motel O Medical office O Office O Retail
❑ Restaurant ❑ Other (explain)
Is this building SO years of apse or more? O Yes D No 1f yM you may aced to contact H&&lurk Pmsrrvj n
If this is for a dsmolMion permit, whet year was the building constructed7
if pdar to 1975, yav *W1 need an o0estos assessment to submit with Ow AA04 aban.
Description of work
*If lawn sprfnlder/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ltrt the c0mpieny name err taty Of R Collins hcenw .a
pecMdan Plumber Mechanical Roofer
other
I hereby adrnowledge dw I have read this application and state that the above information is complete and correct. I agree to
comply with as rerlydremenct contained herein and city ordinances and state laws regulating building constivedon. I that a
peni nit le not vatic until it has been paid and 'awed.
Applicant:
print Name: C ` Signature
Dace p 4. y