HomeMy WebLinkAbout630 SMITH ST - SPECIAL INSPECTIONS - 2/24/2017Planning, Development & Transportation Services
City of Community Development & Neighborhood Services
■ 281 North College Avenue
Fort Collins Fort Co580
llins.
Fort Collins. CO 80522.0580
970.416.2741)
970.224.6134- I'ax
fcgnr.cum
Asbestos Statement Disclosure
KWA7 77
Address Permit #
In accordance with the State of Colorado Senate Bill 13-152, property owners, applying for a
remodel permit, shall indicate their awareness about their property having been inspected for
Asbestos Containing Materials (ACMs).
Property owner, please check the appropriate box below and sign:
❑ 1 do not know if an asbestos inspection has been conducted on this property.
❑ An asbestos inspection has been conducted on this property on or about
An asbestos inspection has not been conducted on this property.
Ut,!� i
S' a ur Date
Your remodel project may be subject to State and Federal Regulations requiring an inspection
for ACMs. Asbestos can be found in these and many other building materials: ceiling tiles and
textures, vinyl floor coverings and mastic, boiler and pipe insulation, heating and cooling duct
insulation, roofing products and clapboard shingles, etc.
For more information about Asbestos or forms, please contact:
Asbestos Compliance Assistance Group
Toll Free: 1-800-886-7689
Phone: (303) 692-3100
littns://wwty.colorado.cov/nac•ific%sites/d(,fault/files/AP ASB-Renovation Demolition.t)dl•
httt)s://tvtvtr. c•oloruclo.gov/cdplie/asbestos
Email address: cdphe.asbestos@state.co.us