HomeMy WebLinkAbout1908 Corvid Way - Applications/Basement Finish - 07/17/2012Planning, Development & Transportation
City Of 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.
Application # _/
For office use only
Incomplete applications will not be accepted.
Date
Job Site Addressfrequired) Value of Construction (labor, materials, profit)
Property / Owner Name
Address /� City/State
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Zip
Phone
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Applicant Name
Address City/State
Zip
Phone
Contractor Lic #
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Address City/State
Zip
Phone
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Contractor City of R. Collins Sales Tax # Are you paying taxes here
or by report?Here ❑ Report
Sales tax number is required by a//mnbactors Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? 31
If residential, is it: VSingle Family Detached
❑ Multifamily (apartment)
Residential ❑ Commercial
❑ Condo/townhome (single family attached) ❑ Duplex
❑ 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 XNo 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.
work
A
*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 #
Electrician L 4A111 PlumberGyL4f"mO4C Mechanical '��0 Roofdq ~ 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: t�l l� /�G1 C�IG�
!Tint Name: Signature Date