HomeMy WebLinkAbout4431 Corbett Dr - Applications/Demolition - 11/09/2012Cit Of Planning, Development & Transportation
F6y 281 N. College Ave P.O. Box 580
rt Collins 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 # b) )_(j"-15�_o Date i��rh2
For office use only
Job Site Address (required) ValVe of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip
Phone
Applicant Name Address
City/State Zip
Phone
r SG)7e-a
Co tractor Lic # Address
City/State Zip
Phone
i -6 D
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bS
- IV7
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
Here
❑ Report
Sales tax number isrequired byall rnnbactors.
Are you paying with your trust account?
❑ Yes
"o
Is this a residential or commercial project? ❑ Residential C9"Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office 9 Retail
❑ Restaurant ❑ Other (explai
Is this building SO 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?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of
NOV
*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 #
Electridarf "G1)y 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 NamejM %�) 7� Tl� Signature Date _�f�