HomeMy WebLinkAbout643 PARLIAMENT CT - APPLICATIONS - 7/10/2013Frowl"oudre Valley Air 9704932073 07/10/2013 11:33 #395 P.002/002
City Of Planning, Development & Transportation
281 N. College"Ave P.O. Box 580
F6rt
CoRi s Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
This application is to be used to apply for the following permits only (check all that apply). I)1ir 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 applicable Information on the application. Incomplete applications will not be accepted. ca�
Application # V ! 5 O!M GG
For office use only
Date _ --A\ ► '\
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name
Address
City/state Zip
Phone
as
Applicant Name
Address
City/state Zip
Phone
Contractor
Address
City/State Zip
Phone
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Contractor City of Ft. Collins sales Tax
#
Are you paying taxes here or by report? ❑ Here
0 Report
Sales tax number is remu/red bya#cmbactors
Are you paying with your trust account? .9Yes
[j No
Is this a residential or commercial project? 'Vkesldential ❑ Commercial
If residential, Is It: mgle Family Detached ❑ Condo/townhome (single family attached) " ❑ Duplex
Crm❑ Multlfamily (apartment) ❑ Garage
If commercial, Is lt: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building so years of age or more? ❑ Yes O No If yes, you may need to contact
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you MY/ need an asbestos assessment to submit with this application. VK{
Description of work ri con n,. 141r�„
*If lawn sprinkler/backnow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L& the company name or City of Ft Collins Ncense
Electrician Oaiz 1 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:�t��?�p�t�n Signature .,�j �� — Date
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