HomeMy WebLinkAbout1226 W Prospect Rd - Applications/Other - 10/05/2011OCT-05-2011(WED) 11:35
P. 001 /001
FCiof
ort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box $80
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 a lacement Roofing Sower Line Photo-voltalc
Ventilation Water Heater Water Line Wood/Pellet Stove FIust be EPA certified, provide make, model and
manufacturer),
Comploto all applicable Information on the application.
Application R Sv
For office use only
Incomplete applications will not be accepted.
Date I oI c-,
Job Site Add s (required)
Value of Construction (labor, materials,
profit)
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Property Owner Name Address
Clty/State ZIP
Phone
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Applicant Name Address
Clty/ tate ZIP
Phone
Contractor Address
CILy/State ZIP
Phone
i r
n
Contractor City of Ft Collins Sales Tax tt
Are you paying taxes here or by report? Here
Report
SalesOxnumbeeisrrnuiredbyarlovaacrarr.
Are you paying with your trust account? Yes
No
Is this a residential or
if residential, Is It:
entla Commercial
Cando/townhome (single family attached) Duplex
Garage
If commercial, Is It: Bank liar Church Hotel/Motel Medical office Office Retail
Restaurant Other (explain)
IS this building 50 years of age or more? Yes No I/ye£ kvu may need to contact Historic Pr=rvation
IF this Is for a demolition permit, what year was the building constructed?
I/prior to J97S, you will need an asbestos assessment to submit with this application:
of
°If lawn sprinkler/baekflow prevcnter, must 115t licensed plumber. If Mrst•tlme A/C, must list licensed eleariclan.
Subcontractors: List the company name or City o(At Collin.- license a
Bearlelan Plumber Mechanl0l Roofer Other
I hereby acknowledge that 1 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-smte laws regulating building construction. I know that a
permit Is not valid until it has been paid and Issued_
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Applicant: 1
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