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HomeMy WebLinkAbout612 E PITKIN ST - APPLICATIONS - 9/9/2015City of Fort C©Wns Planning, Development & Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 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 # 13, SG &"+"I "1 Date 5 For office use only .bob Site Address (required) !Value of Construction (labor, materials, profit) (A 12 -E:aSt Pltkt r, St- 420 db0 Property Owner Name Address City/State Zip Phone P11+ CLUL hran g 2 y ft . CO W ns 0 C0 �652y Applicant Name Address City/State Zip POUR 69p_j L amav- Va.l if CrQFismah Ba.rf _gakra.m 2620 BY-LJSh CYPe - D( F:C. Co 1305zb 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 by all contractors. Are you paying with your trust account? ❑ Yes ❑ No Is this a residential or mmercial project? 9 Residential ❑ Commercial If residential, is it: M Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explai ) Is this building 50 years of age or more? ❑ Yes NNo 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. Description of work d t M o I i -I-i rs,-, o% S I r1A le- f 7 rh i 1 v )h o rv)\ *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 b iiCL Plumber UK WPUC- YiiAechanical�(;�4PCt4;Ir1�iE�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 ordinan s and state laws regulating building construction. I know that a permit is not valid until it has been paid and issued. i Applicant: r a4 ayam Si Print Name: &LLl sdgnats�rn _ ��� " �— Date ��