HomeMy WebLinkAbout919 WOODFORD AVE - APPLICATIONS - 7/9/2012Clty}of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Collins J PhoneFort o4 970-416-2740Fax 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 ❑ 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 # �i� 21-)H1,69 Date
For office use o iy
Job Site Address (required Value of Construction (labor, materials, profit)
iton:;-/ i�
Property Owner Name
Address
City/State Zip
Phone
Applicant Name /
Address
ff��
City/State Zip
Phone
Contractor Lic #
Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report Here ❑ Report
Sales tax number is required by all contractors:
Are you paying with your trust account.
❑ Yes ❑ No
Is this a residential
'If residential, is it:
❑ 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 ❑ No 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 wi/l need an asbestos assessment to submit with this application.
orc9mmercial project? ❑
El Single Family Detached
Description of work
Residential ❑ Commercial
❑ Condo/townhome (single family. attached)
*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 d state that the above information is complete and correct. I agree to
comply with all requirements contained herein and city or 'antes and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: � !' / �-9� Print Name•t� Signature
Date