HomeMy WebLinkAbout2132 Cocklebur Ln - Applications/Sprinkler - 10/06/2011City of fort Collins Building and Zoning Dept. P.O. Box 580 Fort Collins, CO 80522
Phone 970-221-6760 Fax 970-224-6134
a Ct ... City of Foe, Collins OVERmTHEwCOUNTER PERMITS ONLY
Use this application to apply for a permit for any of the following: (check all that apply) ❑ air conditioning, ❑ demolition
(interior non-structural), ❑ electrical alteration (not service change), ❑ gas lighter, ❑ gas line, ❑ gas log, ❑ heating unit,
Xlawn sprinkler, ❑ mobile home replacement, ❑ roofing, ❑ sewer line, ❑ ventilation, ❑ water heater, ❑ water line,
❑ wood stove (*provide model name & number).
Complete all areas of the applications that are applicable to your permit request - Incomplete applications will not be
accepted. An over-the-counter permit will only be valid when it has been paid -in -full and issued.
Application #
Date \\
(for office unse onlly)
Property Owner Name Address zIP Phone
RA AA
Applicant Name Address zip Phone
Contractor Name City Uc # Address Phone
Contractor City of Ft. Collins sales tax # Pay taxes here? )(Yes ❑ No
Job Site Address
Value of Construction (labor, material, profit)
$
Is this a residential project?' AYes ❑ No
If residential is it: A Single family detached ❑ Condo/Townhome (single family attached)) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
Is this a commercial project? ❑ Yes ANo
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 'KNo
If yes, you may need to get historic preservation approval prior to permit issuance.
Description of Work V
**If lawn sprinkler/backflow preventer installation, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: (list the contractor company name or license #)
Electrical Mechanical Plumbing A Roofing Other
I hereby acknowledge that I have read this application and state that the above information is2brrect and agree to comply with all
requirements contained herein and city ordinances and state laws regulating building construction.
Applicant: Print Name ?-
c�t�s \I�l pc�\cR2� SignatureDate