HomeMy WebLinkAbout339 Bannock St - Applications/Sprinkler - 05/04/2012City. a n
Fort 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 d 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 information on the application. Incomplete applications wi of be acceo(ed.
Application # Date rD
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Job Site Address (requ/ ed)
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Value of C nstruction (labor, materials, profit)
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Property Owner Name
Address
ity/State
Zip
Phone
Applicant
Name
Address
ty/State
Zip
Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here OReport
sales tax number I's( u.red byall contractors.
Are you paying with your trust account?
❑ Yes J�No
Is this a residential or commercial project? 21 Residential ❑ Commercial
If residential, is it: mingle 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 P No If yes, you may need to contactH/stodc Preservation
If this is for a demolition permit, what year was the building constructed?
If pnor 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 name 1orCity ofFtCollin, cin503
Electrician Plumber . v �� h�{ef �chanical Roofer Other
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I hereby acknowledge that I have read this application and state that the
comply with all requirements contained herein and city ordinances and s�
permit is not valid until it has been paid and issued.
Applicant:
Print Name:Signature
is complete and correct. I agree to
building construction. I know that a
Date '