HomeMy WebLinkAbout4130 SNOW RIDGE CIR - APPLICATIONS - 5/20/2013Fort 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
❑ Heating Unit, ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
r�
❑ Ventilation Icy Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable iinfor ation on the application. Incomplete ap he lions will n t be accepted.
Application # �l� './���f 2 _Q Date 210 �'7 � 2
For office use only
Job Site Address (required) Value of constru ion (labor, materials, profit)
Prope Olwner 14ame Address
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j� City/State
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Phone
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Applicant NameJ / Address
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City/Slat /, Zvi Phone 770
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Contractor Lic # Address
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City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by a//contractors
Are you paying taxes here or by report? ❑ Here
Are you paying with your trust account? ❑ Yes
❑ Report
❑ No
Is this a residential or commercial project? [9 Residential ❑ Commercial
If residential, is it: WSingle 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?
If prior 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 #
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:
Print Name: > ��' �� VJ / 1 ��1 Signature
DateR, I