HomeMy WebLinkAbout3281 TWIN HERON CT - APPLICATIONS - 1/14/2014FROM :NCA
FAX NO. .:9702299983 San. 14 2013 11:34AM P2/G
Fort Collins
111"� .
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) Cl Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
0 Ventilation Water Heater El 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 # �EA Date
For oti"rae use only
Job Site Address (required)
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. Value of Construction (labor, materials, profit)
Property Owner Name
Address
City/State ft.� ZIP
'Phone
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Appli ame
Address
City/State Zip
Phone
Contractor
Address
City/State zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑.Here XReport
salestarnumber isregvIredbyallmntractors.
Are you paying with your trust account?
%,Yes ❑ No
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Is this a residential or mmercial project? 0Residential ❑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 ❑ Medical office ❑ office 0 Retail
❑ Restaurant ❑ Other (expI
Is this building 50 years of age or more? ❑ Yes No If yes, you mayneed to contact HistoricPreseruation
If this is for a demolition permit, what year was t e building constructed?
If prior to 1973, you will need an asbestos assessment to submit with Misapplication.
Description of work
*If lawn sprinkler/backflow proventer, must list licensed plumber. If first-time A/C, must list licensed electrician,
Subcontractors: List the company name or Gty of Ft Collins license #
EirMirian 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 Nam
Date I —I '7