HomeMy WebLinkAbout4361 WESTBROOKE CT - APPLICATIONS - 1/20/2014FROM :NCA
FAX NO. :9702299983 Jan. 20 2013 04:55PM P4/4
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.Q. Box 580
Fort Colfins, 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 El Gas Log
91 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing El 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 # 1214007W) __ Date 2L
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
24�y` D-
�-Q
_...
Pro rty Owner Name Address
_.u,......,..
City/State Zip
.._ ^.....
Phone
[r W
Applicant Name Address
Clty/State ZIP
Phone
Contractor Address
City/state Zip
Phone alb
�� �n 4 ✓ Y1C . C 12,
G Pt- C_o\ Co SIfSZ
3-
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
XReport
Sales tax number is required by allcontracrrns.
Are you paying with your trust account? Dyes
❑ No
a �ogioz
Is this a residential or commercial project? XResidential ❑ Commercial
If residential, is it: ❑ Single Family Detached 0 Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (expla n)
Is this building 50 years of age or more? ❑ Yes No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was a building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the rompany name or City of Ft Collins lkense #
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 Nam,