HomeMy WebLinkAbout6001 AUBURN DR - APPLICATIONS - 9/28/201109/23/2011 12:03 3032923387
PREMIER PAGE 02/03
City of
planning, Development & Transportation
FortFort Collinsor
N. College Ave P.O. Box 580
L
' 1
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
C] Oemolltion (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 El Water Heater ❑Water Line q 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 # I 10 i� 3n S Date Q •
For office use only
Is this a residential or commercial project? ii(Residential O Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank I7 Bar ❑ Church q Hotel/Motel ❑ Medical office ❑ Office 0 Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes )<No If yes, you may need tv contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
ption of
*If lawn sprinkler/backnow 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 T. Z 1 o t 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: 3 Signature
Date -1 • k• I I