HomeMy WebLinkAbout620 PARK ST - APPLICATIONS - 9/2/2015Planning, Development & Transportation
City of 281 N. College Ave P.O. Box 580
Fort CoWns 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 nn the application. Incomplete applications will not be accepted.
Application # isisms 4 Z—_ Date
For office use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
620 Park St
$12 500
Property Owner Name Address
City/State Zip
Phone
Chris Dinkelman 620 Park St
Fort Collins, CO 80516
970-482-0762
Applicant Name Address
City/State Zip
Phone
Mr. Rooter Plumbing 3801 Godding Hollow Pwky Fort Collins, CO 80516
303-902-6543
Contractor Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
sales tax number is required byall.contractws
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project?
If residential, is it:
If commercial, is it:
❑ Restaurant ❑ Other (explain)
Is this building 5o years of age or more? ❑ Yes [XNo If yes, you may need to contact Historic 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 application.
® Residential ❑ Commercial
❑ Duplex
❑ Single Family Detached ❑ Cando/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
Description of work Excavate sewer two sewer line to perform a pipe burst
❑ Retail
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician PlumberMP-844 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: Brian McGuinness
Print Name: Signature
Date09/02/2015