HomeMy WebLinkAbout619 WHEDBEE ST - APPLICATIONS - 5/20/2019Cit of Planning, Development&Transportation
F�^ 281 N. College Ave P.O. Box 580
i 6rt .Q1Wns 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 LighterGas 6" Sfave
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ hoto-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 # 51 q 6557I5 Date .c oln
For of e use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
eJbee Si+i�4--
3
Property Owner Name
Address City/State
Zip
Phone
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Applicant Name
Address City/State
6"'-
g� ZIP
Phone
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Contractor
Address
Phone
I.1City/statv
Contractor City of Ft. Collins Sales Tax #oboa':�2Bi Are you paying taxes here
by report?
❑ Here �eport
Sales tax number is required by all contractors.
l Are you paying with your trust account?Wes ❑ No
red►'a.d� L'Ceo_SP,g FP-facip
a�j 160�
Is this a residential or compercial project? Wesidentiai ❑ Commercial
If residential, is it: ngle Family Deta d ❑ 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 Preser✓ation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you w111 need an asbestos assessment to submit with this appiicaUon..
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time NC, must list licensed electrician.
Subcontractors: Gist the company name or City of Ft Collins license #
t)Z_ Mechanical Roofer Other
Electrician Plumberi
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: Y riS�-. ,k6�-ek
Print Name: _A 11 i� n
Date S a 0 C1