HomeMy WebLinkAbout932 E PITKIN ST - APPLICATIONS - 6/12/2014From:
06/12/2014 04:20 #127 P.001/002
City Of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
FOr1.} Colons 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 information on the application. Incomplete applications will not be accepted.
Application #
For ofce use only
Date
lob Site Address (requiied)
Value of Construction (labor, materials, profit)
�LiO�f), 9,4�)
Property Owner Name Address
Gty/State Zip Phone
l9 3a
Applican Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
a
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? UrHere *Report
Sales tax number isregwrcdbyall mnna-t s.
Are you paying with your trust account? Yes p No
Is this a residential or commercial project? bl-{esidential 0 Commercial
If residential, is it: kDSingle Family Detached 0 Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage .
If commercial, Is it: 0 Bank 0 Bar ❑ Church 0 Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
0 Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to Contact HWoric 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 app/iptlon -
Description of
-it iawn spnnaer/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty of R Collins /rcense #
Electrician\&&_ plumber Mechanical 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 regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: h `
Print Name: \�(��F - 17�� �m_ Signature L� Date _1