HomeMy WebLinkAbout5701 Sandbar Ct - Applications/Gas - Log, Line, Pipe - 05/03/2016.City of
Fort Collins.
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Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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) 0Gas 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 # 51 W Z Date
For office use only
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Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name
Address City/State
Zip
Phone
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Applicant Name
Address City/State
Zip
Phone
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Contractors
Address City/State
Zip
Phone
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Contractor 6ity of Ft. Collins Sales Tax # Are you paying taxes here or by report? 1M Here
❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes
$L-No
Is this a residential or commercial project? MResidential ❑ Commercial
If residential, is it: ,RSingle 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 SO years of age or more? ❑ Yes ;R No. 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 'X-7' a /t' U c c fs e. AVE S / & c - o
*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 ` 1 ^ OS 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: P_o 6 er 7' _T-e t,-dq Signature
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