HomeMy WebLinkAbout706 Bramblebush St - Applications/Addition or Alteration - 06/07/2012City of Planning, Development &Transportation
281 N. College Ave P.O. Box 580
Fort 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 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 information on the application.
Applicat'ion#d7e
For office use only
Incomplete applications will not be accepted.
Date ir) — 7 -- 12
Sob Site Address (required) Value of ConstrLction (labor, materials, profit)
77Q16- 1$ "567.
Property Owner Name Address
City/State Zip
Phone
l 1
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5a- $33
Applicant Name Address
City/State Zip
Phone,
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Contractor Lic # Address
City/State Zip
Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax �number isrequired byall conb-acmrs.
-Si!5q 302
Are you paying with your trust account?
1
❑ Yes ❑ No
Is this a residential or commercial project? ,KResidential ❑ Commercial
If residential, is it: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 (expla)in)
Is this building 50 years of age or more? ❑ Yes No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the uilding constructed?
If plior to 1975, you will need an asbestos assessment to submit with this application.
*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 #
Electflcia,41AI)z 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 id and issued.
Applicant: Cn��,
Print Name: �� Signature-, G--P.�-.� Date L