HomeMy WebLinkAbout602 KIM DR - APPLICATIONS - 8/7/2018 (3)clty of Planning, Development, & Transportation Services
Fort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.418.2740 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) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
® Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing Q Sewer Line O Photo -voltaic
Cl 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 # G� q)o U S 3a- Date
for office use only
lob Site Address (required) Value of Conction (labor, materials, profit)
P perty ner Name Address City/State Zip Phone
C�g
Applicant Name Address City/State Zip Phone
Fort Collins heating & Air 208 Commerce Dr. #4 Fort Collins, CO 80524 970.484.4552
Contractor Address City(State Zip Phone
Fort Collins Heating & Air 208 Commerce Dr. #4 Fort Collins, CO 80524 970.484AS52
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ■ Report
se4:s tax number Is required by ad cnntrackm Are you paying with your trust account? ■ Yes ❑ No
Is this a residential or commercial project? ■ Residential ❑ Commercial
If residential, Is it: 9 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? ❑ Yes ❑ No 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
*If lawn sprinlder/back low preventer, must list licensed plumber. If first-time A/C, must list licensed eleetridan.
Subcontractors: List the company name or Oty ofR Coffins /iciense #
Electrician plumber Mechmucal H1309 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:
Print Name:_ MDMh Signature �ftDateAl 1 in
Revision data 2MM17