HomeMy WebLinkAbout3303 Grand Canyon Ct - Applications/Gas - Log, Line, Pipe - 05/27/2014City. Of Planning, Development & Transportation
tY 281 N. College Ave P.O. Box 580
Ortt 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) ❑ Electrical Alteration (not service change) ❑ Gas Lighter _ ❑ Gas%99�-V
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Linea 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 applica 'ohs will not a accepted.
Application # sl *oys-43 Date [// 11,
For office use only
Job Site Add
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Value pf Construction (labor, materials, profit)
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?Mere
❑ Report
sales tax number isrequired byall contractors.
Are you paying with your trust account? ❑ Yes
t>a No.
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: mgle 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 contact Historic Preservation
If this Is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will need an asbestos assessment to submit with this application.
work
*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 #
Electridan 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:
Print Name: �� Signature to