HomeMy WebLinkAbout410 WAYNE ST - APPLICATIONS - 3/10/2012CAY or Planning, Development & Transportation
281 N. College Ave P,O. Box 580
Fort COltins 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 se ice change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement. oofing ❑ 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
��occn--the application. Incomplete applications will not be accepted.
Application # `w Date 3 • { - ?r
For ofiiice use only
Is this a residential or commercial project? 19061dential ❑ Commercial
If residential, is it: ;Kngle Family Detached ❑ Condo/townhome (single famlly attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Mobel ❑ Medical office ❑ office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? 01"%ei ❑ No, Yyes, ynu mayneed to contact li&odc Preswvatfon
If this is for a demolition permit, what year was the building constructed?
Ifpnorto 1975 you M11 need an asbestos assessment to submit with this ap#%catfon.
of work
*If lawn sprinkler/bacldlow preventer, must list licensed plumber. Iffirst-time A/C, must list licensed electrician.
Subcontractors; list the company name or oty of FtColfrns /sense #
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 requiremer its 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: LL -- JJ .
Print Name: O U C (�C L 1 n Signature Date 3 (� •