HomeMy WebLinkAbout1713 Brentford Ln - Applications/Other - 09/06/2013City Of Planning, Development & Transportation
Fort Collins For N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-41616-2740 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 O 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 apppliic ions
will not be accepted.
Application # ���(���� Date
For office use only
Job Site Ad (reoui ) Value f Cons ction (labor, materials, profit)
3 e� i 5
Property Owner Name Address �
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Phone qa�)
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Applicant Name /^ Address
City/State / Zip / PhoneC���
Contractor Lic # Address
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Phone '
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Contractor City of Ft. Collins Sales Tax.#
sales tax number is required by allcvntractors
Are you paying taxes here or by report? ❑ Here
Are you paying with your trust account? `XYes
KFReport
❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: gSingle 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? ❑ Yes ❑ No If yes, you mayneed to contactHistoric 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.
Of
*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:
/J� / �L� Si !(
Print Name: (.�/ /c- gnatu Date