HomeMy WebLinkAbout609 WHEDBEE ST - APPLICATIONS - 4/18/2018City Of Planning, Development & Transportation
Fort Collins 281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY _7H5
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 # 511to awlsol
For office use only
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Job Site Address (requred)
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Value of nstruction (labor, materials, profit)
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Property Owner Name
Address
City/State Zip
Phone
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Applicant Name
Address
City/State Zip
Phone
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Contractor
Address
City/State Zip
Phone
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Contr ctor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? Here
❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account? ❑ Yes
P� No
Is this a residential or commercial project? ,.Residential [],Commercial
If residential, is it: ASingle 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 (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pr1or to 1975, you will need an asbestos assessment to submit with this application.
Description of work
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*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 #
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Electrician IZL y I Plumber Mechanical Roofer Other
I hereby acknowledge tha I have read this application and state that the above information is complete and correct. I agree to
comply with all requirem nts contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid u it it has been paid and issued.
Applicant: / / G
Print Name: Signature o�L L Date G�-L� "1 b
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