HomeMy WebLinkAbout616 W OAK ST - APPLICATIONS - 4/6/2017City of Planning, Development, & Transportation Services
Fort Collins 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
❑ Demolition (interior non-structural) metrical 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 # U qn i -9 'S_ Date 61106-z %
For office use only
Job Site Address (required) Value of Construction (labo , materials, profs
7 7�d 3a
Prop Owner Nam Address City/State Zip Phone
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Ap nt Name Address City/State Zip Phone
7G r r 015v T I. r
Co ractor Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number isrequir ldbyallcontractors Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? esidential ❑ Commercial
If residential, is it: g e Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other plain
Is this building SO years of age or more? s 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 _&/ vvi '%r _Alc- Ae%f nn/ A/ 6w_.� C
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that I-havq 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 st t s regulating building construction. I know that a
permit is not valid until it Was been paid a issued.
Applicant: /
Print Name: Signature 2 Date
Revision data 2 12017 / • /