HomeMy WebLinkAbout615 E PLUM ST - APPLICATIONS - 1/27/2016City of
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) ❑ 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.
DI L0004LF 3- WU
Application # B) y COL44 �D " E&M cl--e Date L
For office use only
lob Site Address (required)
Value of Construction (labor, materials, profit)
—.?IUA
Property Owner Name Address
City/State- Zip
Phone
►1%
Applicant Name Address
City/State Zip
Phone
l_L
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 ]It -No
Is this a residential or commercial project? EMesidential ❑ Commercial
If residential, is it: ®'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 (explain)
Is this building SO years of age or more? 0-Yes ❑ No If yes, you may need to contact Historic Preservation (Aire
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work i�r�_.`�s� ,�, s�Me4 e> YtQ:2
*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 # P;'
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 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: UI
Print Name: �E'iYi`c'ociXtk E, e45 1 l L _ signature Date I &1llle'
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