HomeMy WebLinkAbout907 MARBLE DR - APPLICATIONS - 5/14/2013Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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
N Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
O 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 # 913t� 1 a Date 5 - I L4- (3
For offlce use only
Job Site Address (required) Value of Construction (labor, materials, profit)
qb-7 marble- Or. $ 1-113Le.aLo
Property Owner Name
Address
City/State
Zip
Phone
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Applicant Name
Address
City/State
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Zip
Phone
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Lic #
Address
City/State
Zip
Phone
CContractor II
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976-3S3-63)5
Contractor City of . 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
fW76a
Is this a residential or commercial project? B,Residential ❑ 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 ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*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 #
Elect idan 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:
Print Name: Y i (> f Signature Date 5 " 1 4 " tJ