HomeMy WebLinkAbout508 VILLANOVA CT - APPLICATIONS - 2/10/2014Cit
F'Oryt Collins
of
Planning, Development & Transportation
281 N. College Ave P.O. Box 586
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 1% Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable iin��formation�ton the application. Incomplete applications will not be accepted.
Application # 'Ell t/oV Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
$
Property Owner Name Address _
City/State
Zip
Phone
Applicant Name Address
City/State
Zip
Phone
Contractor Lic # Address
City/State
Zip
Phone w �r l -
P S " v- —p I"",� ^c rn P-- 14 1.S 131
A). m4�t< S#
Ffe�2;i/,:'s
frUsZ )
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here Report
Salestaxnumber isrequired byall contractors
Are you paying with your trust account? IKYes ❑ No
ZZ 5-5-7
Is this a residential or commercial project? ® Residential ❑ Commercial
If residential, is it: IR Single 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 5o years of age or more? ❑ Yes ❑ No If yes, you may need to contactHistoric 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 _ - c 1ca c = .W-c4 + p r h P4% N.
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
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.
b. G
Applicant:
Print Name. o Y\
Date