HomeMy WebLinkAbout626 S WHITCOMB ST - APPLICATIONS - 9/10/2018City of Planning, Development & Transportation
F6C 1^' I I , 281 N. College Ave P.O. Box 580
�t Collins 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 ❑ 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 # ') 1� _&W7 Date
For office use only
lob 5ite Address (req fired) �—yL f�j Value of Construction (labor, mates Is, profit)
441
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Property Owner Name Address City/State Zip
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Phone
Applicant Name Address City/St to Zip
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Phone
Co tractor City/State Zip
Phone
/AAdddress
S C / t"4l�LC �.G r7L—
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?
❑ Here
&-Aeport
eNo
5alestax number isrequired bya#contractors Are you paying with your trust account?
06(2:J7?3
❑ Yes
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: -4� Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment)
If commercial, is it: ❑ Bank ❑ Bar ❑ Church
❑ Restaurant
❑ Garage
❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you mayneed 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.
Des Iption of work%#�/� 4n. ! &ram �3' _(o (�, a a-0 117;u-
*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 /�# 9rj
- d
Electrician Plumber Mechanical ( �_j(10 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 anjj state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued. 7 1 yJ
Applicant: lf/
Print Nam Signature
Date
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