HomeMy WebLinkAbout222 JACKSON AVE - APPLICATIONS - 3/13/2018City Of Planning, Development & Transportation
rt Collins
ol'n c For N. College Ave P.O. Box 580
F(5
` J Fort Collins, CO 80524
Phone 970-416-2740 Fax 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 min
Demolition (interior non-structural) Electrical Alteration (not service change) Gas Lighter Gas Log g
Heating Unit Lawn Sprinkler Mobile Home replacement Roofing Sewer Line Photo -
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 Date 3-3`1 0
For office use only
is iris a residential or com erciaLpcnic __ Residential Commercial
If residential, is it: Single Fag& Detached. Condo/townhome (single family attached) Duplex
Mu ti amily (apartment) 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 N 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 application.
Description of work _(- �; Ct % i G(e •+- r r hr (I A i "'-r Ct,C r-ACr f- �Pr l �
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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 0
Electrician ! )I ecf l 1 (✓ 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: ( 11 J
Print Name:` e I}(,{ �'"t`,�lit�(� Signature f:_.�T� I�{7ii.i.1 Date -b'' �3