HomeMy WebLinkAbout644 S WASHINGTON AVE - APPLICATIONS - 5/14/2019Fort Collins
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 ❑ Gas Log
❑ 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 # CAI IJ,J q Date 5/14/2019
For office use only
W 6�
Job Site Address (required)
Value of Construction (labor, materials, profit)
644 S. Washington Ave.
$2,000.00
Property Owner Name Address
City/State
Zip
Phone
Garren Properties PO Box 580
Arden, NC
28704
970-482-9293
Applicant Name Address
City/State I
Zip
Phone
Dave Ruegsegger 2590 Midpoint Dr.
Ft.Collins, CO
80525
970-219-4012
Contractor Address
City/State
Zip
Phone
Merit Electric Inc. 2590 Midpoint Dr.
Ft.Collins, CO
80525
970-266-8100
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or
by report?
❑ Here 8 Report
tax number
s�19
Are you paying with your trust account?
❑ Yes 8 No
Is this a residential or commercial project? B Residential 0 Commercial
If residential, is it: 8 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 Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work Replace the existing meter with a meter/main (not increasing the size) and repair a poorly Installed panel.
*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#
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: Dave Ruegsegger
Print Name:
5/14/2019