HomeMy WebLinkAbout904 PARKVIEW DR - APPLICATIONS - 10/28/20160CT/27/2016/THiJ 01:18 PM
FAX No. P. 006
City of
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, c0 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 q Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation iSilVWater Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information�o(n the application, Incomplete applications will not be accepted.
Application # iJ I �0 � T 6 `B Date 2
For al/`ice use only
Is this a residential or commercial project? FrResidential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) Q Duplex
❑ Multifamily (apartment) 11 Garage
If commercial, is it: Q Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office CI Retail
❑ Restaurant ❑ Other (explai
Is this building SO years of age or more? ❑ Yes RrNo If yes, you may need to contact H/stor/cpre
nervation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you w/ll need an asbestos assessment to submit with this application.
*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 #
Electr1cl8n 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: Jpw-r�� ElAe 9
Print Name:c, ,� signature Date il0