HomeMy WebLinkAbout913 BENSON LN - APPLICATIONS - 11/18/2013Clt Of Planning, Development I& Transportatjon
FtCollins281 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 (cheok all that apply). ❑ Air Conditioning
❑ Demolition (interior non-sfructural)' ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
d Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement • ❑ Roofing 11 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.
Application # rior ofte use
I only I �_ Date
h� -
Job Site Address (required)
Property Owner Name
Applicant Name
Contractor
Tue of Construction (labor, materials, profit)
..16 �-78
Address City/State zip Phone
Address Clty/State ZIP Phone
Address
Zip Phone
Contractor City of Ft Collins Sales Tax # 7
Are you paying taxes here or by report? O Here .trReport
saiestaxnumber rsreQuiiedbyaiimf7o-atOM Are you paying with your trust account? Yes 4 No
Is this a residential or Commercial project? )KfResldential ❑ Commercial
If residential, is It; ', Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel 11 Medical office ❑ Office ❑ Retail
❑ Restaurant. ❑ Other (explain)
Is this building 50 years of age or more? Ei Yesar was the
If yes, you may need it)contactHistorlc Pfeservatlon
If this is for a. demolition ,permit, what year building constructed?
If prior to 1975, you will need an asbestos assessment to subm/t with this application,
Description of
*If lawn sprinklerlbackflow preventer, must list licensed plumber.. If first-time A/C, must Ilst licensed electrician,
Subcontractors: LlstthecDiWanyname.orctvofftCollins1fcen4V#
Electrician PlumbW��� Medwnlcal_H I' i(5
�- Roofer—�_ Other
I hereby acknowledge that I have read this application and state that the above Informatlon is complete and correct. I agree to
comply with all requirements contained herein and city ordinances anif state,
permit is not valid untilaws'regulatlng building constructlon. I know that a
it has been paid and issued,
Applicant: /
Print Name: G.t / / _-C - SignaturesJ'le
Date