HomeMy WebLinkAbout387 Stout St - Applications/Sprinkler - 02/21/2017CityOf planning, Development & Transportation
(� 281 N. College Ave P.O. Box 580
/.,��®[�t C®►bE jj ns 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) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit &[awn 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.
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Application # w 3 15
For office use only
Date ;-) 42 / // 7
Job Site Address (required)
Value of Construction (labor, materials, profit)
387 sT..r s.-.
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Property Owner Name
Ad/dress
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
970 - stl- /3 77
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here a -Report
Sales fax number is required by all contractors.
Are you paying with your trust account?
❑ Yes 11 No
Is this a residential or commercial project? gMesidential ❑ 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 "o 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 wi11 need an asbestos assessment to submit w/tfi this application.
Descriotion of work
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company nameor City of Ft Collins license #
Electrician Plumber /pI`'/f^y /G 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: % /V � Signatu
Date
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