HomeMy WebLinkAbout331 PARK ST - APPLICATIONS - 2/28/2019i°Y �
o_z Planning, ®eve1opmen4 & T'danspoptation Seyvices�
�F`art Colh s Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax 970.224.6134
OVER-THE-CGUNTER PERMIT-8 ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition -(interior non-structural) O 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 informaation on the application. Incomplete applications will not be accepted.
Application # I � � Date Aqg// q
For ofte use only --i - —,-
]lib=SiifeAddress (regWred) Value of Construction (labor, materials, profit)
`� I L�h5oo
Property Owner Name Address City/State
ZiP Phone
,:, I m �,0 1Z;r,,,h el ��► �cr �. 1=rsl•- %' It s � Applicant RbSa i
nt Name Address CI State %9� lyc
ty/ Zip Phone
�i1„a t ?,ram Al YVI,•,.. _ && Lf�- `1 I
Contractor Address
Zip Phone �,a_ ,._ _ .► _ n n .,, _ _ tY/State
Contractor City of R. Collitls� Sales Tax # - -
Con taxnumberls Are you paying taxes here or by report? Here ❑ Report
—� iQy; uiredbyallcontractors Are you paying with your trust account? Yes ❑ No
Is this.a. residential or commercial project? Residential ❑ Commercial
If residential, is it: (,Single Family Detached 0 Condo/townhome (single family attached) ❑ Duplex
E3 Multifamily (apartment) � Garage
If commercial, is it: ❑ Bank 17 Bar ❑ Church 17 Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
Restaurant Is this building so yearsof age or more? ❑ YeOther s q() NoIf yes, you may need to contact HisiodcPreservat/on
If this is for -a, demolition permit, what year was the building constructed?
Description of work
*If lawn sprinkler/backflow preventer, must list licensed.piumber. Y_f. tAc
ime A�
,must list licensed
subcontractors: Ust Me company name or aty ofFt Colllns.11cense #
fflectriUan Plumber
Mechanical__ Roofer — i Lloz
Other
I hereby acknowledge that I have read this application and state that -the above information is complete and correct. I agree to
comply ils:n6 ..repuirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not:valld until It has been -paid and:issued.
Applicant: //�'
print,Name v
1P Cif rl Signature M
®ate 21gaL
nevidan date Ma`17
.L.00 :.