HomeMy WebLinkAbout644 S WASHINGTON AVE - APPLICATIONS - 5/2/2019City of Planning, Development, & Transportation Services
Fart 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 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 V Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application.
Application # oZ15 15
For olrIce use only
Incomplete applications will not be accepted.
Date ",;2
Job Site Address (required) Value of Construction (labor, materials, profit) (D
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Property Owner Name Address Ci /State Zip Phone
fr d i a 0 >2( 5 / f ��/ o Co 90521 q20
Appli it Name Address City Stat Zip Phone
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Contractor Address City/State Zip Phone
JQhh a ArUIP5LLC 11 W 5 V55 704W
Contractor City of t. Co tins Sales Tax # Are you paying taxes here or by report? X Here Report
Sales tax number is required by all contractors Are you paying with your trust account? ❑ Yes No
Is this a residential o commercial project? Residential ❑ Commercial
If residential, is it: Single Family Detad ed ❑ 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 Ce p o e_o_ 2Ir
*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#//�� pp
Electrician Plumber MechanicalRoofer 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 reg m building construction. I know that a
permit is not valid until it has been paid and issued.
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Applicant: I�p���0 5 a I
Print Name: jJ { '' Signature Date
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Revision dale 2/62017