HomeMy WebLinkAbout707 Breakwater Dr - Applications/Addition or Alteration - 01/27/2015Planning, Development &Transportation
City of 1 N. College Ave P.O. Box 580
_ Fort Collins) l 1Fort 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. Incomplete applications will not be accepted. e5?
Application # Date 1_7 11 5-
For ofce use only 16 q4r�
Job Site Address (required)
Value of Construction (labor, materials, profit) 1 -
7 VLJ��
��-• 2� G" II �.s C�s-
Property Owner ame Address
City/State Zip
Phone 5 32-
Applicant Name Address
City/State Zip
Phone
126b W cl2( (L, t&- c,
C -
Contractor Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying 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? JRfResidential ❑ 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 ,E!FNo 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 `ILEP Ifiuf i=X iS-I-ii 6 JFfT ti7ah M I Uq,v i y d l ofV 11
1r1 (d uJ,�
*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
permit is not valid until it has been paid and issued.
Applicant:
Print Name: "y 3
Date -1�