HomeMy WebLinkAbout4436 ROSECROWN CT - APPLICATIONS - 7/27/2011Fort of
Planning, Development & Transportation
281 N. College Ave RO, 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
❑ Ventilation VWater Heater O Water Line ❑ Wood/Pellet Stove (must be EPA certlfled, provide make, model and
manufacturer).
Complete all applicable Information on the application. Incomplete a ap�pllcationnawill not be accepted.
Application #-[ �6 g y 1.9 Date 1 2 1 7 111
For office use only
Job Site Ad as (requ/red)
Value of Construction (labor, materials, profit)
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Wflere ❑ Report
saw nu bar sroquiredbyallconrracrws Are you paying with your trust account? ❑ No
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Is this a residential or commercial project? XResidentlal ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) E3 Duplex
O Multifamily (apartment) ❑ Garage
If commercial, Is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (ex lain)
Is this building 50 years of age or more? ❑ Yes o If yes, you may need to contact Historlc preservation
If this Is for a demolition permit, what year was th bullding constructed?
If prior to 1975, you will need an asbestos assessment In subm/t with th/s appf/cation.
Description of work
-It lawn sprinkier/backflow preventer, must list licensed plumber. If Plrst-time A/C, must list licensed electrician.
Subcontractors: L& Me company name or 01y ofpr Collins lkense #
Electrician Plumber
Mechanical Roofer. Other
I hereby acknowledge that I have read this appllcatlon 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:
PrintName: 1 vl"r "►
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