HomeMy WebLinkAbout3012 Rockborough Ct - Applications/Plumbing - 10/26/2011Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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 replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable info do n the application.
Application # 6` \, 0
For office use only
Incomplete applications will not be accepted.
n Date % (2 v >I
Job Site Addres (required) Value of Constructign_(labor, materials, profit)
'3171'1 V f) C ago u�, �-t <' T 1 $ 1, ' 0-57
Property Owner Name
Address
City/State Zip
Phone
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CldS
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Applic nt Name
Address
City/State Zip
Phho'n7e
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Contractor Lic #
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City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? X Here
❑ Report
Sales tax number is required 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: ❑
11
If commercial, is it: ❑
Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No 1f yes, you may need to contact Historic 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.
Restaurant
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. n /-1
Applicant: r j'—
Print Nama: C i a)wSignature
Date / 6 2c —/
77