HomeMy WebLinkAbout413 Thrasher St - Applications/Sprinkler - 05/02/2017City of Planning, Development, & Transportation Services
Fort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main 970 416 2740 Fax 970 224 6134
OVER-THE-COUNTER PERMITS ONLY �4% -3o
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 # b I �0 Date '5 '
For office use only
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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Contractor Address City/State Zip Phone
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Contractor City of Ft. C ins Sales Tax 4 Are you paying taxes here or y report? ❑ Here ❑ Report
Sales taxnumber isrequired byall cvnbaduis Are you paying with your trust account? ❑ Yes ❑ No
Is this a residenbal or commercial prolect7 *Residential ❑ Commercial
If residenbal, 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 morel ❑ Yes ❑ No If yes, you may need to contact HzWnc Preservabon
If this is for a demolition permit, what year was the building constructed?
D cription of work G,SS
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*If lawn spnnlder/backflow preventer, must list licensed plumber If first-time A/C, must list licensed electrician.
Subcontractors: test the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this applicabon 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 O&WeZa) Signature Q _ Date 5 a 1
Rewwon date MM17