HomeMy WebLinkAbout608 PARK ST - APPLICATIONS - 4/19/2019Fort Coltlns
of
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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 Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter Q Gas Log
❑ Healing Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement,,Ooofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ WoodiPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application. Incomplete applliiccations will not be accepted.
Application # viva �� Date
For o1ce use only
Job Site Add (required)
Value
Vaalluueho ff/Construction (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
Contractor City of Ft. Collins Sales Ta #
Are you paying taxes ere or by report? ❑ Here .tMeport
Saks tax number ismqutredbyair conrwwa
Are you paying with your trust account? es ❑ No
Is this a residential or commercial project? TfResidential ❑ Commercial
If residential, is it: ITSIngle 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 Presenwdon
If this is for a demolition permit, what year was the building constructed?
Ifprlor to 197S, you w411 need an asbestos assessment In submit with this appllcadon.
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*If lawn spn`nkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the company name or U?y ofR Collins hbwse # /
t3ecuidan Plumber Mecharical Roofer Other
I hereby acimowledge 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:�x,l� 5 Sign
Print Name: :7/ Date
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