HomeMy WebLinkAbout621 REMINGTON ST - APPLICATIONS - 5/31/2016Clt of Planning, Development & Transportation
Flirt Collins Fort Cons, CO 80524 .0. Box 580
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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.
Application # �') I � 0 '-A� �-- q
For ofce use only
Date 51 '31 I 1 L9
Sob Site Address (required)
Value of Construction (labor, materials, profit)
1 ' t0Q7S
Property Owner Name Address
City/State Zip Phone
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�2a-2531�r� S
Applicant Name` Address
City/State Zip Phone
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10 < S2-`7 01 7D-cin-2/�al�
Contractor Address
City/State Zip Phone
Contractor City of Ft. ColflQ Sales Tax #
Are you paying taxes here or by report?'B-Here ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? eResidential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
,q P18cA 0 Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No 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
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must
Subcontractors: List the company name or City of Ft Collins license #
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: �\ \ (� (
Print Name ► _ �1 s.1'� Signature__-_� �X. Date 3i 9