HomeMy WebLinkAbout333 Bannock St - Applications/Sprinkler - 05/04/2012Planning, Development & Transportation
F&City Of 281 N. College Ave P.O. Box 580
tColllh 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 gLawn 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.
Application #_ J20z
For office use only
Incomplete applications will n eaccepted.
Date
]ob Site Address required)
533
Value of Co ruction (labor, materials, profit)
Property Owner Name
33
Address
City/State
-�6.k..
Zip
Co '�6'
Phone
Appl' ant Name
qwlae
Address
City/State
Zip
Phone
Contractor
6do6S
7ox
Address
S,Cojle
J City/State
e Ave Cohn
Zip
Lo o5
Phone
o'
,`ale
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here 21 Rteport
Sales tax number i;requiredbyall contractors
Are you paying with your trust account?
❑ Yes S"No
Is this a residential or commercial project? ID -Residential ❑ Commercial
If residential, is it: ZYSingle 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 RfNo 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 com n name 0 of FtColli'%'eas,
Electriaan Plumber -" � M�Ch"apIca
l 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. � �f
Print Name: SignatUre—)IRMWON11