HomeMy WebLinkAbout610 S WASHINGTON AVE - APPLICATIONS - 7/30/2018City of Planning, Development, & Transportation Services
,._,
port 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
❑ Demolition (interior non-structural) ElElectrical Alteration (not seryc ' hnge) all that Gas Lighter ❑❑ AirConditioning
Loigoning
❑ 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 Date
For omce use only
Value of C nstruction
� � (labor, materials, profit)
ro eir Y Owner Name . ( Address City/State Zip Phone
h&79c
Applicant Name Address City/State Zip Phone
Contra Address City/State Zip Phone
Contractor City f . Collins Sales Tax #6V 6'774,� 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? 0Yes
❑ No
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: Single 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?A Yes ❑ No If yes, you may need to conta Histor, Preservation
If this is for a demoli 'on permit, what y ar was the building const cted? / f1'1f �/�_ h fmr icea- 2 al.� C t 1 V 0,
D cription of work - t • — /-
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CI , n �� Lam' /
*If lawn spnnkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name of City of Ft Collins license #
Electrician 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: ,, Iy�, p r
Print Name(1tL / f�l Signat / 1:2�Ae?
re Date /
Revision date 2/612017
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