HomeMy WebLinkAbout6107 ASHTON CT - APPLICATIONS - 9/30/201109/30/2011 14:42 3032923337
City of
Fit Collins
PREMIER
Planning, Development & Transportatlon
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-Z740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
PAGE 03/04
This appllcation 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
C3 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement X Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater 0 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 # BI 10 5,3J5 Date q• °� �� ' Jo?•5S
For ofte use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State
Zip Phone 303,
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Applicant Name Address
City/State
Zip Phone
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Contractor Address
City/State
Zip Phone
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Contractor City of Ft. Collins SaIgs Tax #
Are you paying taxes here or by report? bi Here ❑ Report
Sales raxnumber Isrequired byaumnrracrors.
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Are you paying with your trust account? ❑ Yes )<No
Is this a residential or co mercial project? Residential El Commercial
If residential, is it: Ingle 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 )(No If yes, you may need to contact Historic 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 M& application.
Descri tion of work
1
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W 1 S.
;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; (Y,
Print Name: Signature Date 1 •�b