HomeMy WebLinkAbout809 E PITKIN ST - APPLICATIONS - 11/13/2018C(ty Of Planning, Development & Transportation
281 N. Ave
Fort Collins Fort CoCnIs, CO 80524 P.O. Box 580
Phone 970-416-2740 Fax 224-6134
20
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the followin permits only apply). 9 p y (check all that a I Air Wing.
Demolition (interior non-structural) Electrical Alteration (not service change) Gas Lighter aLc�}i 2
Heating Unit Lawn Sprinkler Mobile Homer ' ent Roofing Sewer Line Photo -
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 # F::) �Q)Uq q ZZ Date
For office use only
Job Site Address (required) Value of Construction (labor,materials, profit)
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Property Owner Name Address
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City/State Zip Phone
P) f Klj� 6-[- F-C 2D6:? R70 -y��l (0033
Applicant Name Address
City/State Zip Phone
Contractor)Address ' City/State Zip Phone
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Contractor City r ui Collins Sales Tax #
Soles tax number srequiredbya//contractors.�14 i
Are you paying taxes here or by report? Here a ort
Are you paying with your trust account? �Y'es No
Is this a residential or com cial r
If residential, is it:- Single Family
Commercial T.
Nnhome (single family attached) Duplex
mumramny (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 Ifyes, you may need to contact Historic P,ervation
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_f�i-DVICL� �I�It //?�,G( �'"Zopi >✓verclroel� (�Joc� bull?r/iq S�v
*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 #
SectricianPlumber
Mechanical Roofer Other
I: hereby.acknowledge that 1-have-read this application and state that tFie 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 theta
permit is not valid until it has been paid and Issued.
Applicant:
Print Name: l Signature J�1a// f
� Date