HomeMy WebLinkAbout432 PLOWMAN WAY - APPLICATIONS - 9/16/2011i.lt of
1 N. College Ave P.O. Box 580
Fort Collins 28
Fort Collins, CO80524
Phone 970-416-27402740 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. Incomplete applications will not be accepted.
Application # Date O H 16111
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
2
R. Co L 11AS
Property Owner Name
Address
City/State Zip Phone
S
1 Z(O Q-+o -Z I q - a Ss
Applicant Name
ddress
City/State Zip Phone
Contractor
Address
City/State Zip Phone
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?Ir,o-or
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Contractor City of Ft. Collins Saes Tax
#
Are you paying taxes here or by report? J0 Here ❑ Report
sales tax number Is required by all contractors.
Are you paying with your trust account? 3S Yes ❑ No
sn 0 3O
Is this a residential or commercial project? RResidential ❑ Commercial
If residential, is it: JgSingle 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 )i'No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work
Errydlh p&o1reA CoAL, k190,r1ko'nC;,_. nstt0l 1Ai <'-w,c{ rec ;�YAt�t S
*If lawn sprinkler/backflow preventer, must list licensed p umber. 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 laps regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant:
Print Name: �Yt2V�(2 ndS Signature Date