HomeMy WebLinkAbout3854 STREAM CT - APPLICATIONS - 8/16/2011City of
Frt 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
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all icable information on the a cation. I mplete applications will not be accepted.
Application # Date
o is use only
Job Site Address (required) Value of Construction (labor, materials, profit)
7RS V . S' ea A*%-- - $A.:'�L o n
Property Ower Name
Address
City/State Zip
Phone
11 '$fo
Applicant Na a J
Address
City/State Zip
Phone
Contractor Lic #
Address
City/State Zip
Phone
el -
15Ss
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
LXkeport
Sales tax number is required by all contradors.�O8,1y
Are you paying with your trust accountzo yes
❑ No
Is this a residential or commercial project? X Residential ❑ Commercial
If residential, is it: PStpgle 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 X 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. CA /i�.p
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: Signature Date