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Home My WebLink About601 COLORADO ST - APPLICATIONS - 2/14/2019Fort Collins Planning, Development & Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 OVER -TIDE -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 #_ CJ \"1 (UD("I }U 3 —qaf ' Date For office, use only YDIq 0 D q I ()U — % Il l 1.C'P , Job Site Address (required) Value of Construction (labor, materials, profit) ©( e.o C9YctJ0 Sf �40 Property Owner Name Address City/State Zip Phone our-ak Ibex,) ,1 a© C-trc_I,e b r- 9- CoII1hS (20 90sa� 970-;u9,SI16 Applicant Name Address City/State Zip Phone MICHAGL cSLAQZ 20 CwMopse0 4 Contractor Address City/State Zip Phone E E sie . CO Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? IWHere ❑ Report &Aestaxnumberisrequiredbyall contractors �Sllo53 Are you paying with your trust account? 11 Yes ❑ No EoEf COLWAGMSS, Is this a residential or commercial project? K Residential ❑ Commercial If residential, is it: Ja Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) W 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 IR No If yes, you may need 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 applicab'on. of work w *If lawn sprinkler/bacMow preveiVer, must list licensed plumb If first-time A/C, must 14 licenseRlectrician. Subcontractors: List the company name or City of Ft collins license # Electrician 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 is not valid until it has been paid and issued. Applicant: - r Print Name: f Signature fiYLCa Date �Skb cvn4 DC WLe_04 k&A" eaa_7R