HomeMy WebLinkAbout617 S WHITCOMB ST - APPLICATIONS - 12/4/2018ftF6City of Planning, Development, & Transportation Services
rt CoRin5 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
13 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit El Lawn Sprinkle El Home replacement ❑ Roofing ElSewer Line ❑ Photo -voltaic
❑ I
Ventilation ❑ Water Heater D 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 # JI R ) n(00--+
For office use only
Date aece*tber 4, 2018
lob Site Address (required) Value of Construction (labor, materials, profit)
617 S WhXcovrulr5tveet; FortCoUZn&,, CO 80521 $5000.00
Property Owner Name Address City/State Zip Phone
7-6mot'hyRanune-s 1721 FeltWCourt FtC011(.vi&,, Co- 80528 303-704-9685
Applicant Name Address City/State Zipp Phone
CiwCWv1 a1I vcu1� 101 S LCY&uLavt.e RCO; CO 805Z4 494-7632
Contractor Address City/State Zip Phone
AUenvSe-rvic& 101 S LLr&�La4w FtCa, CO 80524 484-4841
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? ❑,Mere ❑ Report
Sales taxnumberrsrequilebyall contractors Are you paying with your trust account? V Yes ❑ No
10010
Is this a residential or 5mmercial project? I Residential ❑ Commercial
If residential, is it: 'J Single Family Detached M Condo/townhome (single family attached) la Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: M Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant CI Other (explain)
Is this building 50 years of age or morel ❑ Yes ❑ No 1f yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work ma&v later nw-ter 401t of 3/4"Pzx Materwi.
*If lawn sprinkler/backgow preventer, must list licensed plumber. If first-time A/C, must list licensed elecfixician.
Subcontractors: List the company name or City of Ft Collins license #
Electridar Plumber Medianical Roofer Other
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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: Ghr6Rata.Evan& {
Print Name: Signature 1� (/VW( (,r Date I2-14 b
Revison date 2= 417