HomeMy WebLinkAbout317 Newaygo Dr - Applications/Sprinkler - 11/14/2012Planning, Development &Transportation
Ctty of 281 N. College Ave P.O. Box 580
F 74 C10,11 1, Fort Collins, Co 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
a-7.00
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). $ I g.o �p$c( 0
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # t,�- - - _ u 3 Date
For office use only
(required)
Value of Construction (labor, materials, prof4f
&1�erty
P-JobSiteAddress
Owner Name Address
Gty/State Zip Phone
A
Applicant Name Address
City/State Zip Phone
ContractorAddress
City/State Zip Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ',Here ❑ Report
Sa/Ps tar number isrequiedbyall m7tacftys
Are you paying with your trust account? ❑.Yes No
Is this a residential or commerdal project? jK Residential ❑ Commercial
If residential, is -it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartrnent) ❑ 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 'p No Ifyes, you mayneed to mntactHistoric Preservation
If this. is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you wi/l need an asbestos assessment to submit wiffi this application.
Description of work
*If lawn sprinkler/badcflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the companyname or City of Ft Collins l/cense #
Electrician Plumber �.�y � ®� Mechanical Roofer Other
I hereby admowledge 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 notvalid until it has been pafd and issued.