HomeMy WebLinkAbout331 PARK ST - APPLICATIONS - 11/16/2018FCityof Planning; Development, & Transportation Services
art Collins Community Development &.Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970AI6.2740 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
❑ pemolition(interior non-structural) ❑Electrical:Alteration (not.service change) - ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing 0 Sewer Line '❑. Photo -voltaic
❑ Ventilation 0 Water Heater ❑ Water -Line ❑ Wood/Pellet Stove -(must be EPA certified, provide make, model and
manufacturer).
Complete all.applicable information on the application. Incompleteapplicationswill not be accepted.
Application #�' I� f1_� 0� Date 1�h (p1l of
For office use only
lob Site:Address (required) Value of Construction (labor, materials, profit)
331 .E Cdi I #_� 100 . cro
rty, _Owner Name
Prop a Address City/State Zip Phone
rnrn I 3) ' arlt Ili3. &5aa g70-,;9 -1.4 3
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft.•Colll Sales Tax # Are you paying,taxes here or by report? '0 Here ❑ Report
Sales tax number isrequired by a//ron&actom Are you paying with your trust account? %Yes ❑ No
Is this a residential or commercial project? ]Residential ❑ Commercial
If residential, is it: •ASingle Family Detached, ❑ Condo/townhome (single family attached) ❑Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church Ei Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant 1i Other (explain)
Is this building 50 years.of age -or more? O Yes-gNo 'If yes,, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work R
* f lawn sprinkler/backflow preventer, must ist licensed plumber. 3f time' A/C., must list licensed electrician.
Subcontractors: Ust the company name or city of Ft Collins license #
Electrician Plumber Mechanical Roofer 104a_ Other
I hereby, acknowledge that I have read this application and state:that the aboveinformation 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 IA�P7 )nCkJD00Lin Signatu Date I I� 1 Lp
Revision data 202017