HomeMy WebLinkAbout632 PEYTON DR - APPLICATIONS - 8/10/2011City of
�.,.Porl ColfinS
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 PERMS ONLY
This application is to be used to apply for the following pertnits only (check all that apply)i. ❑ Air Conditioning
O 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
13 Ventilation ❑ Water Heater ❑ Water Line ❑ WoodfPellat Stove (must be EPA certified, provide make, model and
manufacturer)_
Complete all applicable Information on the application. incomplete applications will not be accepted.
Application # u 1 1D 910 S 7 Date
For office use only
]ob Site Address (PWLtimd)
Value of Construction (labor, materials, profit)
i'
Property Owner Name Address
city/state Zip
Phone
n�r r� �nS 8u5
(97o�co8q
1-718
Applicant Name Address
ws;tate Zip
Phone
5
970)
-1710
_Contractor _._........._,.__,. Address
City/state.___ _ Zlp
_
Phone
I} I
2
Q3
Contractor City of Ft Collins sales Tax #
Are you paying taxes here or by report?
❑ Here
X Report
Sales tax number is raquired by all conbadws:
Are you paying with your trust account?
❑ Yes
❑ No
Is this a residentlal or commercial project? ,�1 Residential ❑ Commercial
If residential, is it: ❑ Single Famiiy Detached ❑ Condo/townhome (single family attached) ❑ Dupiex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 5o years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Prosenration
If this Is for a delnoiitiion permit, what year was the building constructed?
Ifprlor to 1975, you wi/l need an asbf stos assessment to submit with this application.
Description of work
*If lawn sprinkler/bacldiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the Company name or CJty of Ft Collins license
Bectridan 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: Signature r. Date