HomeMy WebLinkAbout921 W OAK ST - APPLICATIONS - 8/20/2018FCity Fof Planning, Development & Transportation
6r'l Collins 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 nin
Demolition (interior non-structural) Electrical Alteration (not service thane g
Heating Unit as Log
Lawn Sprinkler Mobile Home replacement Roofing g) Sewer Line hlerI t Alta
Ventilation Water Heater Wafer 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 #_ E 1 -60 (j3C
Forofrce use only
Job S8e Address (required)
vJ • 00-IC 'S1- t%� . C d
Property Owner Name Address
Applicant Name Address
Date_ I
Value of constru
052-1 ction (labor, materials, profit)
76780 ?
City/State Zip Phone
'C . c p 0z1�3 -�igl -._-�c
City/State Zip Phone
Contrador� Address City/State
Fi-/'GE Si P L l4 fD�j le1Jt� ,sti7C- PIZ F-G.�cc) 0Q52& 4
Contractor City of Ft. Collins Sales Tax #
'alestarnumberIs Are you paying taxes here or by report?
requlradbyallcaraadors Are you plying with your trust account?
Is this a residential or
If residential, is it:
Commercial
nhome (' I
Phone
Here e rt
Yes No
Multifamil - singe family attached) Duplex
If commercial, is it: Bank Bar Church Garage
Hotel/Motel Medical office Office Retail
Restaurant Oth la'
Is. this.bukfing.50 years of age or more? - "Yes I You - - -•- -
If this is for a demolition permit, what year was the bui ding constructed? may
Yneed to coritactHistoricPreservation
Ifpriorto 1975, you wilt need an asbestos assessment to submit with this application.
Description of work Awe-p_ r
u �•r.v f 1 D of-t Ur?✓ P --- •,. a r�t-r'1Cle
*If lawn sprinkler/backFlow preventer, must lisi.licensed plumber. If first-time A/C, must list licensed electrician.
Subcontra rs: List the company name or City of Ft Collins license.#
Bearidan t bl eC{Z"-t (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 isnotvalid until it has been paid and Issued.
Applicant:
Print Nam
Signature`,
Date
re