HomeMy WebLinkAbout5101 S Shields St - Applications/Gas - Log, Line, Pipe - 12/30/2014'Ciof
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
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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. Incomplete applications will not be accepted.
Application # 9)Lf I Date
For office use only
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Contractor Citv of Ft. ollins Sales Tax # Are you payi a taxes here or by report? ❑ Here
❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account? ❑ Yes
$ No
Is this a residential or commercial project? ❑
If residential, is it: Single Family Detached
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If commercial, is it: ❑ Bank 11 Bar ❑ Chun
Residential ❑ Commercial
❑ Cando/townhome (single family attached) ❑ Duplex
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h ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building SO years of age or more? ❑ Yes )< No Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pr1or 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 or City of Ft Collins license #
Electrician 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
permii: is noi: valid until it has been paid and issued.
Applicant:
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