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HomeMy WebLinkAbout629 W OAK ST - APPLICATIONS - 6/8/2016Planning, Development & Transportation City. Of ` (� 281 N. College Ave P.O. Box 580 "t O Collins W ti 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 XRoofing ❑ 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 plication: Incomplete applications will not be accepted. Application # P Date o ON For office use only Site Address (required ) Value of Construction. (labor, materials, profit) JSob l9 - VCc `�`�©C� . oc Property Owner Name Address City/State Zip Phone Applicant Name Address City/State Zip Phone Contractor — t �� 3 Address WV_0.J�+ City/State Zip Phone Q *7 O pC3.-17 qc,o-,.rs i.67U.1..�;���1, �.� rc Contractor City of Ft. Collins Sales Tax # Li 1 3 T(e Are you paying taxes here or by report? ❑ Here R Report sales tax number is required by all mnbactois Are you paying with your trust account? 41 Yes ❑ No Is this a residential or commercial project? Id Residential ❑ 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 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 list licensed electrician. 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. .L Applicant: Print Name: ® /� / Signature Date b 0 � 12)LO( I Y U_D -- v4C cam, ri �