HomeMy WebLinkAbout316 Toronto St - Applications/Sprinkler - 05/04/2012Planning, Development & Transportation
"City Of 281 N. College Ave P.O. Box 580
�F6rC}C6111ns Fort Collins, CO 80524
`J 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 XLawn 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 information on the application. Incomplete applications will not:be-epted.
Application # B11025-M
For ofie use only
Date25
Job Site Add �
equired)
(required)
31 ala 54
Value of Constr
ion (labor, materials, profit)
Property Owner Name 316 Address
ity/S to
Zip
Phone
Ap licant Name
�l,-Q r 6
Addre s
,37`
ity/S to
Zip
Phone
Contractor
Address'
ity/State
Zip
Phone
Con actor City of Ft. Collins Sales Tax #
Sales tax number fs-r/equiredbyall contractors.
Are you paying taxes here or by report?
Are you paying with your trust account?
❑ Here eport
❑ Yes No
Is this a residential or commercial project? E( Residential ❑ Commercial
If residential, is it: O 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 !a -No If 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.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company
Electrician Plumber.
license #
I hereby acknowledge that I have read this application and state that the above ii
comply with all requirements contained herein and city ordinances and state laws
permit is not valid until it has been paid and issued.
Applicant:
Print Name: Signature
Roofer Other
is complete and correct. I agree to
building construction. I know that a
Date 47z�