HomeMy WebLinkAbout2208 Thoreau Dr - Applications/Sprinkler - 10/22/2013City Of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
�Or1.} 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) O 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 Sb
manufacturer). 30•
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # Date _V?;_
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name
Address City/State
Zip
Phone
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Applicant Name
Address City/State
Zip
Phone
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Contractor Lic #
Address City/State
Zip
Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
sales tar number is nequlred by all contractors
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential ❑ 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 ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact H/storlc Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you w/l/ need an asbestos assessment to submit with this application.
Description of work - ATX,-ftL <�f�'N,�L, G4044- "— 6/�
*If lawn sprinkler/bacldiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the company name or Gty of Ft Collins license #
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: Signature �/l� �GJ Date /� /