HomeMy WebLinkAbout415 E OAK ST - APPLICATIONS - 6/26/2017City of Planning, Development, & Transportation Services
F„�ort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main 970 416 2740 Fax 970 224 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 # (0 iqo o 4 c>�o Date W • 0-2�0
For ofce use only
]ob Site Address (required) Value of Construction (labor, materials, profit)
11,
Pro rty Owner Name Address City/State Zip Phone
I
Y
Applicant Name Address Gty/State Zip Phone
s a�,- ou
Contractor AckiJess City/State, Zip Phone
L1l U
Contractor City of R. Collins Sales Taxi Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by all contractors Are you paying with your trust account7XYes ❑ No
Is this a residential or ommercial prolect7 Residential ❑ Commercial
If residential, is it: Ingle Family Detach ❑ Condo/townhome (single family attached) El 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 morel ❑ Yes ❑ No If yes, you may need to contact Histonc Preservabon
If this is for a demolition permit, what year was the building constructed?
De tqn of work yes
Si
11
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*If lawn spnnkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Lrst the company name or City of Ft Col%ns 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 Signature Date
Rehww date 2OW017