HomeMy WebLinkAbout645 S WHITCOMB ST - APPLICATIONS - 5/21/2019`a;Lm q
City of Planning, Development, &! Transportation Services
�$ CothnS 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 appiy)AAir 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 [PVater 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 #/bigo&M455-sbL61 9 Date
For ofce use only
Job Site Address (required) Value of Construction (labor, materials, profit)
S ea .
Property Owner Name Address City/State Zip Phone
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Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Mere ❑ Report
sales tax number is required by allconbacto7s. Are you paying with your trust account? VPfes ❑ No
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Is this a residential or commercial project? esidential ❑ Commercial
If residential, is it: ��Single Family Detached❑ Condo/townhome (single family attached) ❑ Duplex
��jj 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 Ifyes, you may need to contact Historic Preservatbn
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty of Ft Collins license #
Electriciarl�_ 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: \
Print Name:SiAt Signature a n�9 .D h Date
Revision dale V612017