HomeMy WebLinkAbout624 TYLER ST - APPLICATIONS - 7/23/2018CityPlanning,
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Fit CO��InS ing, Development, &Transportation Services
Community Development & Neighborhood Services
f 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). Cl Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement '%Roofing ❑ Sewer Une ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater 0 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 # M 5 Date
For office use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
Z 2 FDrk CoWil5 CD SSn52I Ii t7U -
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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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? 13ZHere 1] Report
sa/esbxnumdrrtsrequi aibyallcontractto s. Are you paying with your trust account? ❑ Yes i:No
Is this a residential or commercial project? )lResidential ❑ Commercial
If residential, is it: FfSingle Family Detached ❑ Cando/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 JKrNo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building construed?
Descriptionofwork I�aM611C U5c O-kgeRVig1k SQti00(-YS 4 P(ul fui-in ILPsa
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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 ofFt Collins license #
Electrician Plumber Mechanical Roofer k 'ther
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 lbeen paid and Issued.
Applicant: CVI�t°iVl S6�1e{�(
Print Name: Signature L�/l��/✓1.6�'/tom( Date
Rn,a score MQ017