HomeMy WebLinkAbout932 E PITKIN ST - APPLICATIONS - 6/12/2014 (2)From:
06/12/2014 04:20 #127 P.001/002
Fort 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) 0 Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement ❑ Roofing 0 Sewer Line 0 Photo -voltaic
0 Ventilation ❑ Water Heater 0 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 #N Date U\1a\\a
For olfrce use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
S (PyOo '-1
Property Owner Name Address
_ City/State Zip Phone
Applican Name Address
City/State L'p Phone
Contractor Address
City/State Zip Phone
a
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? WHere *Report
sales tar number is regrdred by all cw &actors.
Are you paying with your trust account? Yes Q Na
Is this a residential or commercial project? residential 0 Commercial
If residential, is it: OTSingle Family Detached 0 Condo/townhome (single family attached) ❑ Duplex
MultMamlly (apartment) 0 Garage
If commercial, is it: O Bank 0 Bar 0 Church ❑ Hotel/Motel ❑ Medical office ❑ Office 0 Retail
11 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?
Yprior to 1975, you will need an asbestos assessment to submit with this application.
Description of worF
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Collins license #
Electridan'6�A S _ Plumber Mechanical Roofer i 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:
Print Name: Signature 4L�r2_ Date tg1\;zA\,A