HomeMy WebLinkAbout2632 Kit Fox Ct - Applications/Gas - Log, Line, Pipe - 03/11/2015City}}of FortPlanning, Development & Transportation
Flit Collins For N. College Ave P.O. Box 580
Collins, CO 80524
� Phone 970-41616-2740 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, 0 Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer) GCOO✓
Complete all. icable information on the application. Incomplete applica ions ill not a accepted.
Application #
For office use only
Date �/0 As
s
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name
� ss��,. Ci /State
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Zip
/ Phone
2 0n_L
Applicant Name
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Address im City/ tate
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Zip
Ph pne
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Co tractor Lic # Address City/State
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Zip Phone 3D)
V1C .410�0
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?'"
ere ❑ Report
Sales tax number is uiredbyallcpa#ucMrs
Are you paying with your trust account?
❑ Yes �fNo
Is this a residential or c mmercial project? .®-Residential ❑ 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 (explain)
Is this building 50 years of age or more? ❑ Yes 1;0o If yes, you may need to contact Historic Preservation
If this Is for a demolition permit, what year was th6 building constructed?
If prior 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 elecbician.
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:( Z-< Si �l
Print Name: is Y �� gnature Date