HomeMy WebLinkAbout4306 NEW BEDFORD DR - APPLICATIONS - 3/3/2014City Of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Flirt Collins 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 (Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application.
Application # B X)1 [60
For office use only
Incomplete applications will not be accepted.
Date 5 232i q
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
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C ntractor Lic #
Address
City/State Zip
Phone
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CO
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
AReport
Sales tax number is required by all contractors
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Are you paying with your trust account?P4,Xes
❑ No
Is this a residential or commercial project? &Residential ❑ Commercial
If residential, is it: Pd 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 50 years of age or more? ❑ Yes A91'-No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprlor to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*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.
Applicant:
Print Name: 4^lnr��_� / u Date