HomeMy WebLinkAbout323 PARK ST - APPLICATIONS - 10/20/2014City of
Fort Collins
Planning, Development & Transportation
781 N. College Ave P.O. Box .580
Fort: Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This applicationAs to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
Q Demolition (interior non-struclu,)p ❑ Electrical Alteration (not service change) L� Gas Lighter Il Gas Log
• Heating Unit ❑ Lawn Sprinkler O Mobile Homo replacement ❑ P,00fing Cl Sower Line ❑ Photo -voltaic
pellet stove (must be EPA certified, prom vide ake, model and
0 Ventilation Ll Water Heater CI Water Llno ❑ Woodl
manufacturer).
Complete all applicable Information on the application. Incomplete applications will not be acceptod.
3)LJ I 10 Z� Date _ �i�o_5>
Application 1l'_�... ---
For oR7ce u v only
Job SitoAAddross (iu�, irrd) , _ Value of Consypuctlon (labor, materials, profit)
11 Clt State Zip
Property Owner. Name Address YI Phone
Applicant Name, Address City/State Zi Pho e
Ctf���D�c'�orY�rr»c�iCO ��� yns�Z
Contractor Address City/State 71p Phone
rsele3taxaUrhb
ntractor Cfty of f=t. Collins Salesiax 9k Are you paying taxes here or by report? 0Here ElReport
rla qurrwdbyvhcontrvctos. Are you paylhu with your trust accohnl7 ❑Yes El No
L-..�G.C�
Is this a residential or, �c mercial project? Residential El Commercial ❑ Duplex
If residential, is it: inyic Famll c i Detaed ❑ Condoltownhome (single family attadied)
�C Mu'Gfnmlly (apartment) ❑ Garage
If cominerdal, Is it; ❑ Bank ❑ 8ar ❑ Church ❑ Hotel/Motol. Q Medical office ❑ Dffice Cl Ralall
❑ Restaurant CI Other (explain) _ �--
Is this building SD years of age or, mole? ❑ Yes I7 No If yes yuu may need to wntact Nlslpnc Areservat/on
IF this is fora dOmolition.permit, what year was the building constructed?
If prior to 19i5, you I4,111 need an asbestos assessment to sl&021t POO this applrcatron
Description•of work
"If lawn sprinkler/backrlow 111'eveatui',9nUst list licensed plumber. ,Ir flrst-I:Ime A/C, must list licensed electrician.
subcontractors: List the coo:pany name or city orFt C 14V lkenst° �'oJ
Plumber—,_—_ Mechanirnl1-�G� _ RoeFer _Other
I hereby acknowledge that I have read this application and state that the above infunnatlon Is conip!eka and correct. I agree to
comply with all rrayulrements contained herein and city ordinances and statr, laws regulating building Cornslruction. I know tbda
permit is not'volV until, it his been paid and issued: .............. _____ .n
Applicant: ��j � '� //y� 0 C7 • 1�--�'
Print Namo,� Signatu _--^ _ Date