HomeMy WebLinkAbout1836 Marlborough Ct - Applications/Plumbing - 01/10/2018C►ty. 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
This application is to be used to apply for the following permits oily (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 info tion on the ap lication Incomplete applications will not be accepted
191
Application # � Date
For offlcVuse Ynly
Job Site Address (required) Value of Construction (labor materials profit),3, (iae?
3G KeA r I bo t 5 , 002L 0 2zl 3(3
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 I Sp Phone
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Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by reports Here ❑ Report
Sales tax number is required by a// contractors Are you paying with your trust account? ❑ Yes �6 No
Is this a residential or commercial project? Residential ❑ Commercial
If residential is it gMultifamily
Single Family Deta led ❑ Condo/townhome (single family attached) ❑ Duplex
(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 ❑ No If yes you may need to contact Histonc Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work —JTe w C k-1 "V-e- C,1164 t� loOP- 141,y 2.0 �� I
*If lawn sprinkler/backnow 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 C�
Print Name 1 Signatu Date 1 /0
ReNsion date 2/6/2017 (f—"
Fol
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