HomeMy WebLinkAbout1906 Sandalwood Ln - Applications/Gas - Log, Line, Pipe - 11/07/2016City of
F6rt Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
This application is to be used to apply for the following permits only (check all that apply).. 0 Air Conditioning
0 Demolition (interior non-structural) 0 Electrical Alteration (not service change) 0 Gas Lighter )( Gas Log y
0 Heating Unit H Lawn Sprinkler 0 Mobile Home replacement 0 Roofing 0 Sewer Line 0 Photo-voltaictft
n Ventilation 0 Water Heater 0 Water Line 0 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 # bl ulo u-1 d0 Date
For office use only
Job Sitee Add ss (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
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City/State Zip (
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Phone cno)
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I Applicant Name Address
City/State J Zip Phon 9- 7z��
Coolactor Address _City/S to Zip
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phone `� 70
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Can ractor. City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
0 Report
Sa/�staxnumberi .r uiredPyalfontractors
Are you paying with your trust account?ILl Yes
No
Is this a residential or commercial project? Residential 0 Commercial
if residential, is it: . Single Family Detached 0 Condo/townhome (single family attached) 0 Duplex
Q Multifamily (apartment) 0 Garage
If commercial, is it: 0 Bank 0 Bar 0 Church 0 ;Hotel/Motel 0 Medical office 0 Office _0 Retail
0 Restaurant 0 Other (explain)
Is this building 50 years of age or more? 0 Yes XNo If yes, you may need to contact Historic preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior 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
permit is not valid until .it has been paid and.issued:
Applicant:
Print lame: Signature pate