HomeMy WebLinkAbout393 Stout St - Applications/Sprinkler - 02/21/2017City of planning, meveCopment & Transportation
281 N. ege Ave
6rtL C®�l(� ns Fort Collins, CO 80524 P.O. Box 580
;
Phone 9770-416-2740 Fax 224-6134
COVED=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 M Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, r^.odel and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # r UA�J Date
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
City/State
Zip
Phone
/ /jAddress
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Contractor Address
City/State
Zip
Phone
TPS /! /i
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BoshX/
/377
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here R Report
Sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes 14-No
Is this z residential or commercial project? ®'Residential ❑ Commercial
If residential, is it: aSingle Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes I&No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pnor to 1975, you will need an asbestos assessment to submit with this application.
Descriotion of work /�+��/'w ��� ✓�-r`�
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed elecbidan.
Subcontractors: ust the company name or C/ty of Ft Collins license #
Electrician Plumber 1"M b XU 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:
Priest Name:
Date